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COMPARISON OF MINIATURIZED PERCUTANEOUS NEPHROLITHOTOMY AND STANDARD PERCUTANEOUS NEPHROLITHOTOMY IN SECONDARY PATİENTS: A RANDOMIZED PROSPECTIVE STUDY.

AIM
We aimed to compare the efficacy and safety of mini percutaneous nephrolithotomy (mPNL) and standard PNL in a group of patients who had history of PNL and/or open renal surgery (secondary patients).


MATERIALS AND METHODS
The study included 148 patients who underwent secondary PNL between November 2016 and September 2018. The patients with kidney stone≥ 2 cm were included in the study. Patients were randomly divided into two groups as mPNL and sPNL. For both groups, demographic data, stone characteristics, operative and postoperative data were recorded prospectively. Data were analyzed at 95% confidence interval and considered significant when p value was less than 0.05.


RESULTS
A total of 148 (76 mPNL, 72 sPNL) patients with a history of PNL and/or open surgery were included in the study. The mean duration of operation was longer in mPNL (106.9 vs 91.2 min, p:0.016). The mean duration of fluoroscopy in mPNL was shorter (4.4 vs 5.3 min, p:0.021). The tubeless procedure was higher in the mPNL (21.1 vs 2.8%, p:0.001). The hemoglobin drop was less in mPNL (0.7 vs 1.4 gr/dl, p:0.011). Duration of nephrostomy and hospitalization was longer in sPNL (p:0.001 and p:0.005, respectively). The success rate in the mPNL group was higher compared to the standard PNL group; however this difference was statistically insignificant (75.0 vs 72.2%, p:0.558).


CONCLUSION
mPNL is superior to standard PNL in terms of hemoglobin drop, duration of fluoroscopy, applicability of a tubeless procedure and duration of nephrostomy and hospitalization among secondary patients. Duration of operation was found to be longer for mPNL. Success rate was higher in the mPNL group, though not statistically significant.