Objective: To present our clinical experiences with micropercutaneous nephrolithotomy in the treatment of moderate-sized renal calculi from a single center. Methods: We retrospectively evaluated the patients with moderate-sized renal calculi who underwent micro-percutaneous nephrolithotomy between December 2012 and Septermber 2013. Results: A total of 68 patients and 70 renal units underwent microperc procedure. Mean age of patients was 41.4 ± 18.8. The mean stone size was 122 ± 83 mm2. The operations were performed under spinal anesthesia in 89.7% of the patients. Stone-free rate was 95.7 % (67/70). Clinically significant residual fragments were observed in three patients. The average duration of operation and mean fluoroscopy time was 40 ± 23 min and 108 ± 72 s, respectively. The mean postoperative drop in hemoglobin was 0.95 ± 0.7 while no patient required blood transfusion. Patients were discharged after an average hospitalization time of 27.5 ± 12.4 h. A total of 4 complications (5.7%), including urinary tract infection (Clavien I) in one patient and renal colics requiring stent insertion (Clavien IIIa) in three patients, were observed postoperatively. Conclusion: Microperc technique is safe, feasible, and efficacious. We suggest that micro-percutaneous nephrolithotomy should be considered for the treatment of moderate-sized renal stones as an alternative to SWL and RIRS failures and also may be considered even primarily.

Keywords:
Micropercutaneous nephrolithotomy, Safety, Feasibility
1.
Fernström I, Johansson B: Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 1976;10:257-259.
2.
Bader MJ, Gratzke C, Seitz M, Sharma R, Stief CG, Desai M: The ‘all-seeing needle': initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 2011;59:1054-1059.
3.
Desai MR, Sharma R, Mishra S, Sabnis RB, Stief C, Bader M: Single-step percutaneous nephrolithotomy (microperc): the initial clinical report. J Urol 2011;186:140-145.
4.
Tepeler A, Armağan A, Sancaktutar AA, Silay MS, Penbegul N, Akman T, Hatipoglu NK, Ersoz C, Erdem MR, Akcay M: The role of microperc in the treatment of symptomatic lower pole renal calculi. J Endourol 2013;27:13-18.
5.
Armagan A, Tepeler A, Silay MS, Ersoz C, Akcay M, Akman T, Erdem MR, Onol SY: Micropercutaneous nephrolithotomy in the treatment of moderate-size renal calculi. J Endourol 2013;27:177-181.
6.
Rassweiler JJ, Renner C, Eisenberger F: The management of complex stones. BJU Int 2000;86:919-928.
7.
de la Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV, Wolf JS Jr, Grabe M, Gravas S; CROES PCNL Study Group: Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-255.
8.
Romero V, Akpinar H, Assimos DG: Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010;12:e86-e96.
9.
Clark JY, Thompson IM, Optenberg SA: Economic impact of urolithiasis in the United States. J Urol 1995;154:2020-2024.
10.
Albala DM, Assimos DG, Clayman RV, et al: Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 2001;166:2072-2080.
11.
Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M: Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 2011;108:896-899.
12.
Turk C, Knoll T, Petrik A, et al: Guidelines on urolithiasis. European Association of Urology, 2012.
13.
Ghoneim IA, Ziada AM, Elkatib SE: Predictive factors of lower calyceal stone clearance after Extracorporeal Shockwave Lithotripsy (ESWL): a focus on the infundibulopelvic anatomy. Eur Urol 2005;48:296-302.
14.
Al-Ansari A, As-Sadiq K, Al-Said S, Younis N, Jaleel OA, Shokeir AA: Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones. Int Urol Nephrol 2006;38:63-67.
15.
Khalil MM: Which is more important in predicting the outcome of extracorporeal shockwave lithotripsy of solitary renal stones: stone location or stone burden? J Endourol 2011;26:535-539.
16.
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M: Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2009;4:CD007044.
17.
Turk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C: Guidelines on urolithiasis. European Association of Urology, 2011.
18.
Dretler SP: Stone fragility - a new therapeutic distinction. J Urol 1988;139:1124-1127.
19.
Pittomvils G, Vandeursen H, Hellemans J, Demeulenaere R, Matura E, Boving R, Baert L: Stone geometry and structure dependence on extracorporeal shock wave lithotripsy. J Endourol 1993;7:357-362.
20.
Pareek G, Hedican SP, Lee FT Jr, Nakada SY: Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 2005;66:941-944.
21.
Hatipoglu NK, Sancaktutar AA, Tepeler A, Bodakci MN, Penbegul N, Atar M, Bozkurt Y, Söylemez H, Silay MS, Istanbulluoğlu MO, Akman T, Armagan A: Comparison of shockwave lithotripsy and microperc for treatment of kidney stones in children. J Endourol 2013;27:1141-1146.
22.
Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD: Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 2002;167:31-34.
23.
Sabnis RB, Jagtap J, Mishra S, Desai M: Treating renal calculi 1-2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int 2012;110:E346-E349.
24.
Knoll T, Jessen JP, Honeck P, Wendt-Nordahl G: Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol 2011;29:755-759.
25.
Traxer O, Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013;189:580-584.
26.
Jackman SV, Hedican SP, Peters CA, Docimo SG: Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 1998;52:697-701.
27.
Silay MS, Tepeler A, Atis G, Sancaktutar AA, Piskin M, Gurbuz C, Penbegul N, Ozturk A, Caskurlu T, Armagan A: Initial report of microperc in the treatment of pediatric nephrolithiasis. J Pediatr Surg 2013;48:1578-1583.
28.
Kim SS, Kolon TF, Canter D, White M, Casale P: Pediatric flexible ureteroscopic lithotripsy: the children's hospital of Philadelphia experience. J Urol 2008;180:2616-2619.
29.
Hatipoglu NK, Tepeler A, Buldu I, Atis G, Bodakci MN, Sancaktutar AA, Silay MS, Daggulli M, Istanbulluoglu MO, Karatag T, Gurbuz C, Armagan A, Caskurlu T: Initial experience of micro-percutaneous nephrolithotomy in the treatment of renal calculi in 140 renal units. Urolithiasis. 2014;42:159-164.
30.
Desai J, Solanki R: Ultra-mini percutaneous nephrolithotomy (UMP): one more armamentarium. BJU Int 2013;112:1046-1049.
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2015
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