Presented by: Dipak Rajyaguru M Ch urology
UROCARE, Shanku Hospital

Introduction

Patients with spinal deformity (SD) pose specialchallenge in stone management due to altered anatomy andcompromised respiratory function. Retrograde intrarenal surgery (RIRS) is an established standard of care in the modernliterature. However, this is not a viable options in remote areasof India due to large stone burden and limited economic andtechnological resources. Under these circumstances mini PCNL(mPNL) yields an alternative minimally invasive treatment option as a treatment for stone disease. We seek to evaluate safety and efficacy of this approach in large renal stone burden in patients with spinal deformity.

Materials

We have studied 92 patients with spinal deformitiesbetween 2000 to 2023. Large total stone burden was defined as all patient with a stone greater than 1.5 cm. Spinal deformitieswere- varying amount ( scoliosis, kyphosis, lordosis andKyphoscoliosis). Stone size was calculated with the help of CTIVP after confirming  their operative fitness. All children andelderly population deemed medically unfit for surgery wereexcluded. General anesthesia was used in all cases. Allpercutaneous access was established via use of Fluoroscopyguide puncture using standard technique and the percutaneoustract was dilated up to 14F, 16F or 18F dilators. All stones werefragmented to dust with the help of the 30 wt holmium laser 365fiber as wells as mini pored lithoclast. 5.0Fr double J stent andpercutaneous drain was placed and all patients were evaluatedwith a KUB on post operative day 1 and were discharged on day2.

Results

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There were a total of 92 patients and 70(76.3%)were male . Mean age was 45yrs (32-62 yrs). Stone location wasas follows: renal pelvis 45 (48.9%); Pelvis and calyx -29(31.6%), only calyx 18 cases (19.6%). Four patients werecomplete staghorn. Mean operative Time was : 50 minute (20-120) min. Complete clearance was 84 (91.4%), remainingrequired relook mPCNL for clearance . Minor complications in11 patients (12.2%) (minor bleeding in 7 , culture positiveinfection in 4) occurred 14( 15.2%) , major complications in 10 patients (11%) (bleedingrequired transfusion in 6 patients,persistent urine leak from surgery site in 2, hydrothorax in 1 andcolonic rupture in 1)

Conclusion

The mPCNL is safe effective in patients with spinal deformities and large renal stones. Stringent patientselection and pre-operative stone mapping is very important.

Financial conflicts and Disclosure statement - None

Source of funding - None

Funding

None

Lead Authors

Vipul Tilva, M Ch urology
HCG hospital

Co-Authors

Hemang Baxi, MCh urology
HCG hospital

Jitendra Amlani, MCh urology
UROCARE hospital