Minimally invasive percutaneous nephrolithotomy: a comparative study of the management of small and large renal stones

Abstract

Objective: To compare the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) between small (<2 cm) and large (>2 cm) renal calculi, because although MIP has proved its efficacy in small lower caliceal stones, the efficacy in large renal calculi has been questioned.

Materials and methods: The data from 191 consecutive minimally invasive percutaneous nephrolithotomy (MIP) procedures at a single institution from January 2007 to March 2011 were reviewed retrospectively. All stone sizes and complexity were included (98 were <2 cm and 93 were ≥ 2 cm). We performed a comparative analysis of procedures for calculi <2 cm and ≥ 2 cm regarding the stone-free rate, the need for auxiliary procedures, and complications. The Student t test for parametric continuous variables and the chi-square test or Fischer's exact test for nominal variables were applied.

Results: The primary stone-free rate was significantly lower for the large than for the small stones (76.3% vs 90.8%, P = .007), and the secondary stone-free rate after one auxiliary procedure (second-look percutaneous nephrolithotomy, ureterorenoscopy, or shock wave lithotripsy) was not significantly different between the 2 groups (94.6% vs 98.9%, P = .1). The total complication rate was not significantly different (26.9% vs 19.4%, P = .2) between the 2 groups either. Grade III complications occurred in 5.2% of all patients, and no grade IV or V complications were observed.

Conclusion: Using MIP, the total stone-free rate was greater for the small than for the large calculi; however, most patients could be rendered stone-free with the use of one auxiliary procedure. The high success rate and low rate of higher grade complications justify the application of MIP for large stones.