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Supine mini percutaneous nephrolithotomy: a method worth considering as the gold standard for treating renal stones – an experience from a tertiary referral centre

Authors:

L. N. Seneviratne ,

Sri Jayawardenapura General Hospital, LK
About L.

Consultant Urologist & Transplant Surgeon

Department of Urology & Transplant

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C. Wickramsekera,

Sri Jayawardenapura General Hospital, LK
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Y. Mannikage,

Sri Jayawardenapura General Hospital, LK
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C. Hingalagoda,

Sri Jayawardenapura General Hospital, LK
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J. Rajasinghe,

Sri Jayawardenapura General Hospital, LK
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S. Udurawana,

Sri Jayawardenapura General Hospital, LK
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W. C .M. Samaraweera,

Sri Jayawardenapura General Hospital, LK
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N. J. Jahan,

Sri Jayawardenapura General Hospital, LK
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C. Pilimatalawwe

Sri Jayawardenapura General Hospital, LK
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Abstract

Introduction
Mini PCNL was developed with the use of 15 - 18 F sheaths (instead of the conventional 24 - 30 F) to reduce morbidity that is seen in standard PCNL. Performing mPCNL in the supine position further adds to its many advantages including shorter operative time. This largest series evaluates the overall benefits observed in patients undergoing supine mPCNL for the treatment of renal stones in Sri Lanka.


Material and methods
Five hundred and five patients with renal and/or upper ureteric stones (in 509 kidneys) who underwent mPCNL between January 2016 - December 2020 were studied. Radiological evaluation was performed by CT scan. Holmium: YAG laser was used for stone fragmentation using a 12F nephroscope through 15 Amplatz sheath under fluoroscopic guidance. Patients clinical and treatment outcomes were evaluated in terms of stone-free rate, operative time, hospital stay and complications.


Results
Mean age was 48.85 years (14-80). There was a male preponderance. The majority (92.3%) being ASA I and II. The mean BMI was 25.32kgm-2 of whom 42.2% were overweight and 16.8% were obese. The mean stone diameter was 24.5 mm(9-45mm) and density1064Hu. The majority of stones (57.3%) had a GUYS score I while 13.4% were complete staghorn. The predominant approach was a single tract, subcostal lower pole puncture. However, multitrack PCNL was performed in 38(7.5%) patients. The complete stone-free rate achieved was 84.1%. Mean operative time was 87 min while the median hospital stay was 4 days. The overall complication rate was 21.5%(n=109), the majority of which being Clavien Dindo class I. No deaths, renal loss or conversion to open surgery were observed.

Discussion
Mini-PCNL in supine position should be considered more often for renal stone management in Sri Lanka not only due to its wide safety margin and effectiveness but also because of its rapid turnover time.

How to Cite: Seneviratne LN, Wickramsekera C, Mannikage Y, Hingalagoda C, Rajasinghe J, Udurawana S, et al.. Supine mini percutaneous nephrolithotomy: a method worth considering as the gold standard for treating renal stones – an experience from a tertiary referral centre. Sri Lanka Journal of Surgery. 2021;39(2):11–7.
Published on 31 Jul 2021.
Peer Reviewed

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