Comparing the pros and cons of PCNL techniques
13 Jul 2015 - Joel Vega
Stone specialists today have a range of techniques using percutaneous nephrolithotomy (PCNL) in managing challenging cases. However, with the introduction of various procedures, tools and the many ways stone fragments are extracted, deciding on the best strategy and approach can be tricky.
At the upcoming 3rd Meeting of the EAU Section of Urolithiasis (EULIS15) in Alicante, Spain, to be held from September 10 to 12, the issue of determining the most optimal strategy for patients (such as in the elderly, children or those with obesity) will be discussed and examined during one of three video sessions scheduled on the meeting’s second day.
Prof. Guohua Zeng (Guangzhou, China) will discuss his techniques in a video presentation on “Super-Mini-Perc: Lower calix/unfavorable anatomy.”
“Super Mini-Perc (SMP) has advantages over mini-PCNL or standard PCNL, including fewer complications, faster recovery, shorter hospital stay and fluoroscopy times, with a much lesser possibility of using a drainage catheter after the procedure,” said Zeng.
But SMP differs from the Ultra Mini-Perc (UMP) and the Micro-PCNL in the way stone fragments are expelled. “In UMP the stone fragments are removed using either pressurized irrigation or are left behind for spontaneous passage by the patient. In Micro-PCNL the stone fragments are simply left in situ for later spontaneous passage. In SMP the stone fragments are removed by negative pressure aspiration,” explained Zeng.
The goal of the video sessions is to clarify current issues and examine both advantages and disadvantages of the various techniques. During the session experts can also exchange ideas, discuss best practices and explore prospects and innovations.
In Alicante, Zeng will focus on the design features of SMP and how it works. Since complication is the most worrying issue in PCNL, these complications tend to be associated with the accuracy of tract placement and the size of the nephrostomy tract, according to Zeng.
He added that the basic requirements for a good miniature PCNL system are small size endoscope and access sheath that can still offer good entry and exit of the irrigation fluid, efficient extraction of stone fragments, a clear visual field, and low intra-luminal pressure.
“SMP was designed along these principles. The basic components of the SMP system are 7 Fr. miniature nephroscope with enhanced irrigation capability and a modified nephrostomy sheath with continuous negative pressure aspiration,” he explained. “Its design was intended not only to prevent the excessive intra-renal pressure but also improve visualization and stone fragments extraction. In addition, there is no routine need of using a drainage catheter after the procedure.”
Zeng said participating in conferences like the EULIS meeting will enable specialists to widen their perspectives. “By sharing surgical skills or communicating how our practices impact our treatment strategies, we can further develop treatment procedures and provide better care to the benefit of patients,” he said.
He also noted many other issues in stone treatment which deserves closer attention such as the necessity of prophylaxis antibiotics in the endoscopic treatment of urinary tract calculi, choosing the best type of minimally invasive technique (ESWL, RIRS, UMP, SMP) in treating lower pole stones less than 2cm, and updates on stone formation mechanism and the prevention of the stone recurrence, among other topics.
The EULIS meeting in Alicante is the third following the 2013 EULIS Meeting in Copenhagen and a 2011 meeting in London, with both meetings attracting a growing number of specialists and urologists interested in urolithiasis management.