الفهرس 
Introduction and aim of the work
Anatomic considerationsOnly 14 pages are availabe for public view
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Abstract
Renal stone disease is one of the most common problems in
urological practice. PNL is the gold standard treatment for large and
complex renal stones. The techniques of PNL have developed over the
last several years especially with miniaturization of instruments and
optics which lead to refinement of percutaneous access techniques.
Minimally invasive PNL (MIP) has been established in the
treatment of small renal calculi. However, there is an ongoing debate
whether MIP can safely and effectively be applied in the treatment of
larger sized renal calculi.
This is a prospective clinical study. It was done in two tertiary
centers; in Assiut, Egypt and Tuebingen, Germany. The goal of this study
was to evaluate the efficacy and safety of MIP in management of large
renal stones and to compare its outcomes with those of the conventional
PNL.
One hundred fifty patients with 165 renal units were included in
the study, divided into two groups; Assiut group underwent conventional
PNL (42 procedure) and Tuebingen group underwent MIP (123
procedure). All the stones were larger than 2cm. The primary success rate
was 76.4% and 61.9% for MIP and conventional groups respectively with
no significant difference. While after an auxiliary procedure the stone
free rate reaches 94.3% and 92.8% for both groups respectively. Stone
burden and number of tracts were found to be independent factors
determining the primary success rate of MIP.
Percentage of complications was 19.5% and 33.3% for MIP and
conventional PNL groups respectively with no significant difference.
Most of the complications encountered in both maneuvers were of minor
grade and were managed conservatively (grade I and II modified Clavien Summary
99
grading). Blood transfusion was required in conventional PNL patients
significantly more frequently than MIP group (p<0.001).
Intraoperative time was 101 and 100 minutes for MIP group and
the conventional group respectively. Duration of hospital stay was 4.3
and 4.9 days for MIP group and the conventional group respectively.
An important factor that might explain these outcomes is that the
mean stone burden for conventional PNL group (62.2 ± 38.5) was
significantly higher than that of MIP group (38.7 ± 23.4mm) (P<0.001).
Superiority of one technique over the other cannot be concluded
from the study. Further prospective randomized studies with large sample
size should be encouraged to ensure these preliminary results.