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| The clinical outcomes of laser with suction device in mini-percutaneous nephrolithotomy |
Abhishek Gajendra Singh( ),Sundaram Palaniappan,Shrikant Jai,Gopal Tak,Arvind Ganpule,Ravindra Sabnis,Mahesh Desai
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| Department of Urology, Muljibhai Patel Urological Hospital, Virendradesai Marg, Nadiad, Gujarat, India |
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Abstract Objective: To evaluate the safety, efficacy and feasibility of laser with suction device in mini-percutaneous nephrolithotomy (mini-PCNL).
Methods: A retrospective study was conducted including 200 patients who underwent mini-PCNL for renal stones. All patients underwent PCNL using Electro-Medical Systems laser. In addition to the laser in 100 patients, a suction device was used (laser with suction [LWS]). In the other 100, suction device was not used (laser with no additional suction [LOS]). Mini-PCNL was performed using standard technique and Karl Storz minimally invasive PCNL-medium system was used. Primary end point was stone clearance.
Results: Both the groups were comparable in terms of demographic data. Mean stone size was 15.24±5.90 mm and 16.16±5.53 mm in LWS and LOS, respectively. Mean Hounsfield unit of stone was 1285.64 and 1206.79 in LWS and LOS, respectively. Operative time was less in LWS group (56.89±19.65 min) as compared to LOS (62.01±28.81 min). At one-month follow-up, radiological complete clearance was 96% in LWS and 92% in LOS. On subgroup analysis of stones larger than 18 mm, the clearance rate was in favour of LWS (85.7% vs. 100%) and also the need for nephrostomy placement was less in LWS group.
Conclusions: LWS device is safe and efficacious when used with mini-PCNL. For stones greater than 18 mm, it has a better stone free rate as compared to using no suction.
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Received: 22 April 2020
Available online: 20 January 2022
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Corresponding Authors:
Abhishek Gajendra Singh
E-mail: drabhisheksingh82@gmail.com
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The diagrammatic representation of laser with suction device. EMS, Electro-Medical Systems.
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The laser with suction device.
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| Variables | Laser with suction (n=100) | Laser without suction (n=100) | p-Value | | Agea, year | 41.2 (18.5) | 43.3 (18.2) | 0.41 | | Males, n (%) | 78 (78) | 68 (68) | 0.11 | | Patients with multiple stones, n (%) | 54 (54) | 26 (26) | <0.01 | | Stone sizea, mm | 15.5 (5.9) | 16.2 (5.5) | 0.43 | | Hounsfield unit of stonea | 1286 (245) | 1207 (284) | 0.04 |
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Demographic characteristics of patients (n=200).
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| Variable | LWS (n=100) | LOS (n=100) | p-Value | | Operative time, mina | 56.9 (18.8) | 62.0 (28.8) | 0.14 | | Nephrostomy, n (%) | 30 (30) | 37 (37) | 0.14 | | Stent placement, n (%) | 41 (41) | 37 (37) | 0.41 | | Hospital stay, daya | 1.8 (1.0) | 1.7 (1.0) | 0.66 | | VASa | | 6 h | 5.0 (2.1) | 5.4 (2.3) | 0.18 | | 12 h | 3.1 (1.4) | 3.3 (1.6) | 0.57 | | 24 h | 0.8 (1.1) | 0.8 (1.1) | 0.85 | | Hb drop, g/dLa | 1.2 (1.4) | 1.2 (0.9) | 0.86 | | Stone free rate, % | 96 | 92 | 0.23 | | Auxiliary procedure | 0 | 1 (relook nephroscopy on Day 3) | 0 | | Complications, n (%) | | Grade 1 | 4 (4) | 4 (4) | 0.58 | | Grade 2 | 3 (3) | 0 | | Grade 3 | 1 (1) | 2 (2) |
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Comparison of mini-PCNL with and without laser suction (N=200).
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| Variables | LWS (n=29) | LOS (n=35) | p-Value | | Mean stone sizea, mm | 22.6 (5.3) | 22.2 (4.39) | 0.75 | | Mean Hounsfield unit of stonea | 1321 (181.7) | 1182 (322.58) | 0.04 | | Operative timea, min | 58.4 (21.25) | 65.5 (28.34) | 0.27 | | Nephrostomy, n (%) | 6 (20.7) | 20 (57.1) | 0.003 | | Stent placement, n (%) | 12 (41.4) | 11 (31.4) | 0.41 | | Hospital stay, day | 1.7 | 2.1 | 0.30 | | VASa | | 6 h | 4.7 (2.0) | 6.0 (2.2) | 0.02 | | 12 h | 3.3 (1.3) | 3.2 (1.4) | 0.77 | | 24 h | 0.59 (0.90) | 0.97 (1.12) | 0.14 | | Hba, g/dL | 0.94 (0.66) | 1.32 (1.10) | 0.13 | | Stone free rate, % | 100 | 85.7 | 0.03 | | Complications, n (%) | | Grade 1 | 1 (3.4) | 5 (14.3) | 0.14 | | Grade 2 | 0 | 0 | | Grade 3 | 0 | 0 |
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Comparison of mini-PCNL with and without laser suction in patients with stone size >18 mm.
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