Presented by: Conner Brown MD
Hadassah Medical Center

Introduction

Since the advent of the percutaneous nephrolithotomy (PCNL) complications such as bleeding, need for blood transfusion, the risk of pseudoaneurysm have driven many Endourologists to seek improvements to the techniques and methods used during these procedures. One major shift in recent years has been the introduction of the “ultra-mini” PCNL, a technique that utilizes percutaneous access of 12-14Fr as compared to 26-30Fr used during a standard PCNL. The objective of this study is to compare bleeding related complications between standard PCNLs and ultra-mini PCNLs.

Materials

A retrospective analysis on a database of patients who underwent standard or ultra-mini percutaneous nephrolithotomy procedures from 2006 to 2022 (n=807) was performed to identify patients who developed any post-operative complications, Clavien-Dindo grade 1-5, (n=121). A subset of data was then identified in which the patient had any bleeding complication (n=22), required a blood transfusion, and/or eventually required selective angio-embolization (n=8), then further delineated into standard PCNL and ultra-mini PCNL groups.

Results

,

Of the total complications (n=121), 98 where in the standard group and 20 where in the ultra-mini group, while the balance of 3 developed complications after the case was aborted prior to tract dilation. Standard PCNLs were more likely to result in a bleeding complication as compared to ultra-mini (n=21 vs n=0, P=0.002). The standard PCNL group also required significantly more blood transfusions when compared to the ultra-mini group (n=17 vs n=0, P=0.009). No statistical difference was observed between the standard and ultra-mini groups when comparing rates of selective angioembolization (n=8 vs n=0, P=0.12). No deaths in either group were observed.

Conclusion

Ultra-mini PCNLs result in fewer bleeding related post-operative complications and blood transfusions when compared to standard PCNLs. While the rate of pseudoaneurysm requiring selective angioembolization is statistically insignificant, none of the ultra-mini PCNLs performed during this time frame went on to undergo this intervention. Further analysis of the rates of selective angioembolization in ultra-mini PCNLs as compared to standard PCNLs is warranted once the sample size has increased by a sufficient margin.

Funding

None

Lead Authors

Eli Heifetz, PhD
The Jerusalem College of Technology

Co-Authors

Amitay Lorber, MD
Hadassah Medical Center

Leonid Boyarsky, MD
Hadassah Medical Center

Mordechai Duvdevani, MD
Hadassah Medical Center