Ultra-mini PNL (UMP): Material, indications, technique, advantages and results.

Stone disease has afflicted mankind since centuries; records from ancient civilisations of India and Egypt have shown stones in human bodies. The scientific mind of humans has always made smart endeavours to remove the kidney stones. From large instruments made like the beaks of different animals and birds in 600 BC (Indian civilisation) to extremely sophisticated and miniaturised endoscopic intruments of today the human race has travelled a long way. The theme has always been to remove the stones with minimal morbidity and mortality and with minimum pain to the patient. The article takes you through the journey of instruments used in 600 BC until today. The story of instrumentation is a symbiosis of the medical minds along with engineering advances. The story of miniaturisation could not have moved further without the development of lasers, fiberoptics and sophisticated cameras. As the field stands today, we remove more complex stones by larger endoscopic intervention and smaller stones by miniaturised instruments. The article discusses all the merits and shortcomings of various techniques: from open surgery to standard PCNL to Mini PCNL to Ultra- Mini PCNL to Micro-PCNL.

Prospective outcomes of 11-13Ch. ultra-mini percutaneous nephrolithotomy (UMP): A consecutive cohort study.

Ultra mini PCNL (UMP) has been described as a less invasive technique of PCNL for the treatment of small to medium sized stones in attempt to reduce the surgical morbidity. OBJECTIVE: Evaluate prospectively the outcomes of UMP. METHODS: Single surgeon prospective concurrent cohort study of UMP in India. Effectiveness was assessed by stone-free rates, operative time, complications including transfusion, sepsis rates, length of stay and analgesic requirements. RESULTS: In 2013, data on 98 consecutive patients who underwent UMP was collected prospectively. Mean stone size (±SD)was 15.85 ± 4.53mm. The mean Hounsfield unit (HU) was 1105 ± 165HU. Access to the kidney was from the upper pole (8), interpolar (36) and lower pole(55) with no instances of failed access. Mean operating time was 54 minutes (range 28-120 minutes). The mean change in haemoglobin was -0.81g/dl and mean change in creatinine was 0.05mg/dl. No patients were transfused or suffered acute kidney injury. There were fiveClavien-Dindo complications (Grade I x4, IIIb x 1) with the most serious being a perinephric collection requiring intervention. Post-operative oral analgesia was sufficient in 89 patients (91%) with 9 patients (9%) requiring IM or IV analgesia. Median length of stay was 30 hours (IQR 10 hours). 13 patientshad nephrostomy drainage. 8 patients required a stent for one week. Intraoperatively, 98% of patients were stone free on fluoroscopy, which was 76% on day 1 post op ultrasound and 83% on CT at 1 month. Stone free was the absence of detectable calculi. CONCLUSIONS: UMP for 10-20mm stones appears to be effective and safe with few complications and a short length of stay. Further multicentre studies are required but if confirmed, UMP may be a valuable addition to the armamentarium of the endourologist.

Ultra-Mini PNL (UMP): material, indications, technique, advantages and results / Ultra-mini PNL (UMP): Material, indications, technique, advantages and results

Stone disease has afflicted mankind since centuries; records from ancient civilisations of India and Egypt have shown stones in human bodies. The scientific mind of humans has always made smart endeavours to remove the kidney stones. From large instruments made like the beaks of different animals and birds in 600 BC (Indian civilisation) to extremely sophisticated and miniaturised endoscopic intruments of today the human race has travelled a long way. The theme has always been to remove the stones with minimal morbidity and mortality and with minimum pain to the patient. The article takes you through the journey of instruments used in 600 BC until today. The story of instrumentation is a symbiosis of the medical minds along with engineering advances. The story of miniaturisation could not have moved further without the development of lasers, fiberoptics and sophisticated cameras.As the field stands today, we remove more complex stones by larger endoscopic intervention and smaller stones by miniaturised instruments. The article discusses all the merits and shortcomings of various techniques: from open surgery to standard PCNL to Mini PCNL to Ultra- Mini PCNL to Micro-PCNL

La enfermedad litiásica ha afligido a la humanidad desde hace siglos. Registros de antiguas civilizaciones de India y Egipto han mostrado piedras en cuerpos humanos. La mente humana científica siempre ha realizado esfuerzos inteligentes para eliminar las piedras renales. Desde los instrumentos grandes hechos como los picos de diferentes animales y pájaros en 600 AC (Civilización India) a los instrumentos endoscópicos extremadamente sofisticados y miniaturizados de hoy en día la raza humana ha recorrido un largo camino. El tema ha sido siempre eliminar las piedras con una mínima morbilidad y mortalidad y con el mínimo dolor para el paciente. El artículo le lleva a través del viaje de los instrumentos utilizados en 600 AC hasta hoy en día. La historia de la instrumentación es una simbiosis de las mentes médicas a lo largo de los avances de la ingeniería. La historia de la miniaturización no podría haber avanzado sin el desarrollo de los láseres, fibras ópticas y cámaras sofisticadas. Actualmente, eliminamos las piedras más complejas con intervenciones endoscópicas mayores y las piedras más pequeñas con instrumentos miniaturizados. El artículo discute todos los méritos y deficiencias de diferentes técnicas: desde cirugía abierta hasta NLPC estándar, mini NLPC

Prospective outcomes of 11-13Ch. Ultra-Mini Percutaneous nephrolithotomy (UMP): a consecutive cohort study / Resultados prospecticvos con la ultra-mini nefrolitotomía percutanea (11-13 Ch.): estudio de una cohorte consecutiva

Ultra mini PCNL (UMP) has been described as a less invasive technique of PCNL for the treatment of small to medium sized stones in attempt to reduce the surgical morbidity. Objective: Evaluate prospectively the outcomes of UMP. Methods: Single surgeon prospective concurrent cohort study of UMP in India. Effectiveness was assessed by stone-free rates, operative time, complications including transfusion, sepsis rates, length of stay and analgesic requirements. Results: In 2013, data on 98 consecutive patients who underwent UMP was collected prospectively. Mean stone size (±SD) was 15.85 ± 4.53mm. The mean Hounsfield unit (HU) was 1105 ± 165HU. Access to the kidney was from the upper pole (8), interpolar (36) and lower pole (55) with no instances of failed access. Mean operating time was 54 minutes (range 28-120 minutes). The mean change in haemoglobin was -0.81g/dl and mean change in creatinine was 0.05mg/dl. No patients were transfused or suffered acute kidney injury. There were fiveClavien-Dindo complications (Grade I x4, IIIb x 1) with the most serious being a perinephric collection requiring intervention. Post-operative oral analgesia was sufficient in 89 patients (91%) with 9 patients (9%) requiring IM or IV analgesia. Median length of stay was 30 hours (IQR 10 hours). 13 patientshad nephrostomy drainage. 8 patients required a stent for one week. Intraoperatively, 98% of patients were stone free on fluoroscopy, which was 76% on day 1 post op ultrasound and 83% on CT at 1 month. Stone free was the absence of detectable calculi.Conclusions: UMP for 10-20mm stones appears to be effective and safe with few complications and a short length of stay. Further multicentre studies are required but if confirmed, UMP may be a valuable addition to the armamentarium of the endourologist

La ultra mini NLPC (UMP) ha sido descrita como una técnica de NLPC menos invasiva para el tratamiento de las piedras pequeñas y medianas en un intento de reducir la morbilidad quirúrgica. Objetivo: Evaluar prospectivamente los resultados de la UMP. Metodos: Estudio prospectivo de una cohorte concurrente de UMP con un único cirujano en India. La eficacia fue evaluada mediante el porcentaje de pacientes libres de litiasis, el tiempo operatorio, las complicaciones, incluyendo transfusión, tasas de sepsis, tiempo de estancia y necesidades analgésicas. Resultados: En 2013, se recogieron prospectivamente los datos de 98 pacientes consecutivos que habían sido sometidos a UMP. El tamaño medio (± DE) de la piedra fue de 15,85 ± 4,53mm. La media de unidades Hounsfield (UH) fue de 1105 ± 165. El acceso al riñón se realizó por el polo superior (8), interpolar (36) y por el polo inferior (55), con ningún caso de acceso fallido. El tiempo operatorio medio fue de 54 minutos (Rango 28-120 minutos). La media del descenso de la hemoglobina fue de -0,81g/dl y el cambio medio de la creatinina de 0,05mg/dL. Ningún paciente fue transfundido o sufrió daño renal agudo. Hubo cinco complicaciones (4 de Grado I Clavien- Dindo, 1 Grado IIIb) siendo la más grave una colección perinéfrica que requería intervención. La analgesia oral postoperatoria fue suficiente en 89 pacientes (91%) y 9 pacientes (9%) requirieron analgesia IM o IV. La mediana de estancia hospitalaria fue de 30 horas (Rango interquartílico 10 horas). 13 pacientes tuvieron tubo de nefrostomía. 8 Pacientes necesitaron un catéter durante 8 días. Intraoperatoriamente, 98% de los pacientes quedaron libres de litiasis en fluoroscopia, siendo el 76% en ecografía el primer día postoperatorio y 83% en TAC al mes. Se definió libre de litiasis como la ausencia de cálculos detectables. Conclusiones: La UMP parece ser eficaz para piedras entre 10-20 mm, con pocas complicaciones y una estancia corta. Se requieren más estudios multicéntricos, pero, si se confirma, la UMP puede ser una adición valiosa para el armamentario del endourólogo