Initial Experience Using the Minimal Invasive Percutaneous Nephrolitholapaxy Technique in Management of Renal Stones.

Introduction and Objectives. The aim of this subject is to present the results of the initial experience with the minimal invasive percutaneous nephrolitoholapaxy (MIP) technique in the Urology Clinic from SCJU Arad. Materials and Methods. The Urology Clinic from SCJU Arad, reported 15 cases of renal and ureteral lithiasis who underwent MIP technique between November 2018 - February 2019. All patients signed the informed consent, blood and urine samples were collected preoperatively, in order to assess the biological status of patients. Stone size (largest diameter) was measured on x-ray, the strategy of intervention was planned by consulting the urographic or computed tomographic images, by case. Interventions were performed under spinal anesthesia and prophylactic antibiotics were administered to all patients preoperatively. An 16 Ch Storz nephroscope was used, lithotripsy being achieved with an 30 W Ho:YAG Auriga QI laser, finally a 14 Ch - balloon nephrostomy was inserted. Results. The mean age of patients was 48 years (range 24 - 72 years), the mean operative time was 47 minutes (range 35 - 59 minutes). Patients had a single stone, either located in the renal pelvis or in the middle and lower calyces. Particular cases: one case of horseshoe kidney, one case of surgical solitary kidney, one case of sepsis with patient under anticoagulant treatment, one case of pregnancy, one case of bilateral staghorn calculi with chronic renal disease and one case of stone located on the lumbar ureter. The mean stone size was 14 mm (range 8 mm - 20 mm), except the case of bilateral staghorn calculi (3.4 - 5 cm diameter, 80 minutes). The clinical and biological status of patients, analyzed postoperatively, showed no significant hemorrhage, one cases complicated with acute pyelonephritis, stone free rate was achieved in percent of 87.4%, nephrostomy ablation time between 24-48, mean hospitalization time 4 days, better tolerance and low pain for smaller nephrostomy tubes. Conclusions. MIP technique is a better alternative in the treatment of small and medium size renal stones. The postoperative complications are minimal, and the stone free rate is similar to classic percutaneous nephrolithotomy, also in selected cases and with surgeon's experience, MIP can exceed the contraindications, in order achieve maximal therapeutic results. [ABSTRACT FROM AUTHOR]