Figure 1: The novel super-mini percutaneous nephrolithotomy 14Fr access sheath, developed by ClearPetra.
The patients included in this current study were selected only if they were not suitable for shock wave lithotripsy or retrograde intrarenal surgery, thus necessitating a percutaneous approach for stone ablation. Patients were included in the study following a minimum of 3 months follow up postoperatively using the SMP technique. Perioperative outcomes, including operative time, hemoglobin drop, transfusion rate, and pain score, were recorded for all patients. Additionally, quality of life assessments was made using the EQ-5D-5L Value Set before surgery and 6-weeks following surgery. Stone free status was confirmed via ultrasonography 6-8 weeks postoperatively.
Dr. Celentano presented his current findings from a total of 28 patients who underwent SMP between January 2016 to January 2018. Of these patients, 89% were totally tubeless, while 10.7% had tubes sited. Fifty-three percent of patients have a less than 24 hours admission and the mean hospital stay was 1.2 days. The mean hemoglobin drop was 1.36 g/dL and no patients required a blood transfusion. For these 28 patients, 27 (96.5%) were stone free at 3 -month follow up. Interestingly, there was a significant improvement in mean pain score of SMP as compared to normal percutaneous nephrolithotomy (PCNL) (1.25 vs. 3.25, respectively). Similar to this finding, quality of life was also shown to significantly improve with SMP, with an average of improvement of the quality of life score from 75 preoperatively to 87.25 postoperatively.
Dr. Celentano concluded his presentation by reiterating his preference for this novel procedure. Though this is an initial clinical trial at a single center, the early results of SMP tend to demonstrate the technique is safe and effective in the treatment of stones less than 20 mm. Through this round of experimentation, the procedure was associated with low levels of blood loss, short operating times, high rates of tubeless procedures, a short length of stay, and improved patient quality of life. Dr. Celentano endorses this procedure but recommended that further experimentation is completed in order to properly determine whether this technique is superior to traditional PCNL.
Presented by: Dr. Giuseppe Celentano
Co-Authors: Giuseppe Celentano, Michael Mikhail, Vimoshan Arumuham, Ali Tasleem, Clare Allen, Navin Ramachandran, Simon Choong
Author Affiliation: Stone and Endourology Unit, Institute of Urology, University College London Hospitals NHS Foundation Trust, London, England
Written by: Zachary Valley, Twitter: @ZacharyAValley, Department of Urology, University of California-Irvine, medical writer for UroToday.com at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France