Mini-percutaneous nephrolithotripsy in the structure of surgical treatment of patients with nephrolithiasis
The objective. To assess the effectiveness of mini-percutaneous nephrolithotripsy in treatment of patients with nephrolithiasis with stone sizes from 10 to 15 mm. Materials and methods. We conducted a retrospective analysis of 183 medical histories of patients who stayed and were treated at the urological clinic of Novosibisrk Regional Clinical Hospital with a single renal stone 10 to 15 mm in the period from 2010 to 2016. All patients were divided into 4 groups depending on the way of stone removal: in group 1 (n = 28) mini-percutaneous nephrolithotripsy was performed (mini-PERc); in group 2 (n = 87) - percutaneous nephrolithotripsy (PCNl); in group 3 (42 patients) - extracorporeal lithotripsy (ESWL); in group 4 (n = 26) - transurethral contact pyelolithotripsy (TUCLT). We assessed the duration of surgery, completeness of stone removal, complications, number of secondary unplanned procedures, length of the rehabilitation period. Results. The most complete removal of stone was noted in group 2 - in 84 patients (96.55%) US and/or x-ray control at the end of the procedure and on the next day found no residual fragments, in 2 patients clinically insignificant fragments up to 3 mm were found and in one - a 5 mm fragment, later an ESWL procedure was performed with complete destruction of this fragment. Complete elimination by the time of discharge was observed in 84 (96.55%) patients. Analysis of the main inflammatory blood indices (WBC, leukocytic index of intoxication, middle molecules) and body temperature reaction within the first 24h after surgical intervention found that the least dynamics as compared with the initial values was noted in group 3, and the greatest in group 1, in groups 2 and 4 they were approximately similar. The greatest number of secondary unplanned procedures (9) was performed in group 4 (34.61%), namely: PCNL - 5, ESWL - 3, punction nephrostomy - 1; and in group 3 - 7 (16.67%): percutaneous nephrolitholapaxy (PCNLL) - 2; pelvic catheterisation - 3, stent catheter placement - 1; punction nephrostomy -1; while the least number of unplanned manipulations (3) was noted in group 2 - (3.45%), namely: ESWL - 1; correction of the nephrostomy tube position - 2, and in group 1 - 1 correction of the nephrostomy tube position (3.75%). Conclusion. When determining a method for active removal of stones, mini-PERC is surgery of choice in case of stone sizes 10 to 15 mm in any localisation of the pelvicalyceal system due to its greater effectiveness as regards ESWL and transurethral surgery. The effectiveness of this method is comparable to standard PCNLL but has less complications.