Re: Agrawal et al. Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal

• Main Author: Kamarulzaman, Mohd Nazli
• Format: Article
• Language: English; English; English
• Published: Medknow 2017
• Subjects: RD Surgery
• Online Access: http://irep.iium.edu.my/56287/1/IndianJUrol000-813092_223509.pdf; http://irep.iium.edu.my/56287/7/56287-Re_Agrawal%20et%20al.%20Ultra-mini-percutaneous%20nephrolithotomy_SCOPUS.pdf; http://irep.iium.edu.my/56287/8/56287-Re_Agrawal%20et%20al.%20Ultra-mini-percutaneous%20nephrolithotomy_WOS.pdf; http://irep.iium.edu.my/56287/; http://www.indianjurol.com/text.asp?2017/33/1/90/195762

The authors demonstrate a successful reduction in size from 30F for conventional PCNL to 11F in ultra-mini-PCNL. This reduction will reduce tissue trauma and bleeding.[1] Further, they did not routinely use a nephrostomy or stent which will possibly allow us to categorize ultra-mini-PCNL as less invasive than conventional PCNL. However, the question which is not solved from this study was regarding the specific indication for this procedure. In this study, the authors used this procedure to treat renal stone (pelvis, upper calyx, middle calyx, and lower calyx) and upper ureteric stone size between 8 and 20 mm. The other methods of treatment were well established their specific indication. For example, in the European Association of Urology guideline, PCNL is recommended therapy to treat large renal stone (>20 mm) and smaller stones (10–20 mm) of the lower renal calyx when unfavorable factors for shockwave lithotripsy (SWL) exist.[2] Retrograde intrarenal surgery (RIRS) was recommended in treating lower pole renal stone <20 mm.[2]