EURURO Vol. 72 No. 2

220 320

Platinum Priority – Stone Disease
Editorial by Mahesh R. Desai and Arvind P. Ganpule on pp. 236–237 of this issue
Tract Sizes in Miniaturized Percutaneous Nephrolithotomy:
A Systematic Review from the European Association of Urology
Urolithiasis Guidelines Panel
Yasir Ruhayel [1_TD$DIFF] Abdulkadir Tepeler Saeed Dabestani Steven MacLennan Alesˇ Petrˇı´k
Kemal Sarica Christian Seitz Andreas Skolarikos Michael Straub Christian Tu¨rk
Yuhong Yuan Thomas Knoll
a Department of Urology, Ska˚ne University Hospital, Malmo¨, Sweden; bDepartment of Urology, Sen [8_TD$DIFF]Jorj [9_TD$DIFF]Austria [10_TD$DIFF]Hospital, Istanbul, Turkey; c Academic Urology
Unit, University of Aberdeen, Aberdeen, UK; dDepartment of Urology, Region Hospital, Cˇ eske´ Budeˇjovice, Czech Republic; e Department of Urology, First
Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; f Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital,
Istanbul, Turkey; g Department of Urology, Medical University [11_TD$DIFF] Vienna, Vienna, Austria; h Second Department of Urology, Sismanoglio Hospital, Athens
Medical School, Athens, Greece; i Department of Urology, Technical University Munich, Munich, Germany; j Department of Urology,[4_TD$DIFF] Hospital[13_TD$DIFF] of the Sisters of
Charity, Vienna, Austria; k Department of Medicine, McMaster University, Hamilton, Canada; l Department of Urology, Sindelfingen-Boeblingen Medical
Center, University of Tu¨bingen, Sindelfingen, Germany
available at
journal homepage:
Article info
Article history:
Accepted January 30, 2017
Associate Editor:
Giacomo Novara
Keywords:
Mini-perc
Percutaneous nephrolithotomy
Residual fragments
Stone surgery
Stenting
Systematic review
Urinary calculi
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Abstract
Context: Miniaturized instruments for percutaneous nephrolithotomy (PNL), utilizing
tracts sized 22 Fr, have been developed in an effort to reduce the morbidity and
increase the efficiency of stone removal compared with standard PNL (>22 Fr).
Objective: We systematically reviewed all available evidence on the efficacy and safety
of miniaturized PNL for removing renal calculi.
Evidence acquisition: The review was performed according to the Preferred Reporting
Items for Systematic Reviews and Meta-analyses statement. Since it was not possible to
perform a meta-analysis, the data were summarized in a narrative synthesis.
Evidence synthesis: After screening 2945 abstracts, 18 studies were included (two
randomized controlled trials [RCTs], six nonrandomized comparative studies, and 10 case
series). Thirteen studies were full-text articles and five were only available as congress
abstracts. The size of tracts used in miniaturized procedures ranged from 22 Fr to 4.8 Fr.
The largest mean stone size treated using small instruments was 980 mm2
[7_TD$DIFF]. Stone-free
rates were comparable in miniaturized and standard PNL procedures. Procedures per-
formed with small instruments tended to be associated with significantly lower blood
loss, while the procedure duration tended to be significantly longer. Other complications
were not notably different between PNL types. Study designs and populations were
heterogeneous. Study limitations included selection and outcome reporting bias, as well
as a lack of information on relevant confounding factors.
Conclusions: The studies suggest that miniaturized PNL is at least as efficacious and
safe as standard PNL for the removal of renal calculi. However, the quality of the
evidence was poor, drawn mainly from small studies, the majority of which were
* Corresponding author. Department of Urology, Klinikum Sindelfingen-Bo¨blingen, University of
Tu¨ bingen, Arthur-Gruber-Strasse 70, 71065 Sindelfingen, Germany. Tel. +49 7031 9812501;
Fax: +49 703 9812354.
E-mail address: (T. Knoll).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.