Microperc with Self-Assembled Fr 4.85 Visual Needle and Ureteral Access Sheath

Abstract

Background

Micropercutaneous nephrolithotomy (microperc) is the least invasive among percutaneous nephrolithotripsy (PCNL) procedures. Although microperc has a high stone-free rate and certain advantages over other methods, modifications may be needed to improve the technique. We describe our experience performing microperc using a self-assembled visual needle and ureteral access sheath (UAS).

Methods

Between June 2016 and April 2019, the data of 30 patients with kidney stones undergoing microperc with our self-assembled 4.8 Fr visual needle combined with a UAS was retrospectively analyzed. Patients were placed in an obilique spine lithotomy position.

Results

Two cases were excluded: one due to conversion to mini PCNL and the other required flexible ureteroscopy during microperc. The remaining 28 cases included 18 men and 10 women, age 38.4 ± 7.5 years, stone size 1.7 ± 0.4 cm, and stone density on CT 969 ± 233 HU. Operative time was 47 ± 9.9 minutes, visual analogue scale score of tract pain on postoperative day 1 was 2.5 ± 1.0, hemoglobin decrease was 6.4 ± 1.0 g/L, and hospital stay was 3.1 ± 0.8 days. There was 1 case of fever and urinary infection, 2 cases of hematuria, and 1 case of flank pain. All symptoms resolved after conservative or antibiotic treatment. On postoperative day 1, 12 (42.9%) caseswere stone-free. The stone-free rates at postoperative month 1 and 3 were 92.9% (26/28) and 100% (28/28), respectively.

Conclusions

Our self-assembled visual needle and UAS instrument is effective for microperc. Use of the UAS may improve the operative outcome.

Keywords:

• Micropercutaneous nephrolithotomy
• microperc
• ureteral access sheath
• kidney stones
• percutaneous nephrolithotripsy

Acknowledgment

The authors thank Nissi S. Wang for developmental editing of this manuscript. We thank all the cases for their participation in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jiqing Zhang, Ning Kang, and Yuguang Jiang. Jiqing Zhang and Junhui Zhang provided the concept and design the instrument and perform the surgery. The first draft of the manuscript was written by Jiqing Zhang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.