Journal of endourology · 2026
Suction-Assisted Miniaturized Percutaneous Nephrolithotomy Outcomes in Anomalous Kidneys: A Multicenter Prospective Study-An EAU-Endourology Collaboration.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Gauhar Vineet, Lim Ee Jean, Somani Bhaskar Kumar, Kalathia Jaisukh, Beltrán-Suárez Edgar, Nariman Gadzhiev, Laymon Mahmoud, Petkova Kremena, Acuna Esteban, Lakmichi Mohamed Amine, Fong Khi Yung, Zawadzki Marek, Kumar Nitesh, Mehta Amish, Teng Roy Zen Sing, Tak Gopal Ramdas, Martov Alexey G, Cepeda Marcos, Malkhasyan Vigen, Chawla Arun, Castellani Daniele, Herrmann Thomas R W, Yuen Steffi Kar Kei
Аннотация
BACKGROUND: Renal stones in anomalous kidneys pose surgical challenges due to altered anatomy. Miniaturized percutaneous nephrolithotomy (mini-PCNL) reduces morbidity, but concerns remain about stone-free rates (SFRs) and infection. Suction-assisted mini-PCNL (SM-PCNL) enhances fragment removal and controls intrarenal pressure, but its role in anomalous kidneys is unclear.
OBJECTIVE: To evaluate perioperative outcomes of SM-PCNL in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies.
METHODOLOGY: This prospective study across 15 centers (January-December 2024) included 287 adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. SFR was assessed via a 30-day non-contrast CT: 100% stone-free (Grade A), residual fragments ≤4 mm (Grade B), or >4 mm/multiple (Grade C, requiring reintervention).
RESULTS: Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with holmium laser (50.9%), thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative clearance was 95.4%. At 30 days, 93.4% achieved Grade A, 5.6% Grade B, and 1.0% required reintervention. Complications were low; 0.7% had sepsis requiring intensive care unit admission. No transfusions or pleural injuries occurred.
CONCLUSION: SM-PCNL using 18F suction sheaths with laser in a single stage achieved 93.4% complete SFR with negligible complications and minimal reintervention.
OBJECTIVE: To evaluate perioperative outcomes of SM-PCNL in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies.
METHODOLOGY: This prospective study across 15 centers (January-December 2024) included 287 adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. SFR was assessed via a 30-day non-contrast CT: 100% stone-free (Grade A), residual fragments ≤4 mm (Grade B), or >4 mm/multiple (Grade C, requiring reintervention).
RESULTS: Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with holmium laser (50.9%), thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative clearance was 95.4%. At 30 days, 93.4% achieved Grade A, 5.6% Grade B, and 1.0% required reintervention. Complications were low; 0.7% had sepsis requiring intensive care unit admission. No transfusions or pleural injuries occurred.
CONCLUSION: SM-PCNL using 18F suction sheaths with laser in a single stage achieved 93.4% complete SFR with negligible complications and minimal reintervention.