229 320
Bhattu 2014, case
series, India, 2009–2013,
abstract
[29]NA
mPNL 20Fr
NA
Benefits: SFR
Harms: BL, CG
Secondary outcomes:
DP, DHS, AR
301 NA SFR: 297 (99%)
BL: 1.01 g/dl
CG 1: 2%, CG 2: 5%
DP: 59 min
DHS: 2.9 d
AR (tramadol): 54 mg
NA
NR
Ureteric catheter: 98
Ureteric catheter +
nephrostomy: 26
DJ stent: 110
DJ stent + nephrostomy: 28
Nephrostomy: 39
mPNL is alternative to
standard PNL for medium
renal stones, with better
morbidity profile. However
there is no comparison group.
Tubeless mPNL associated
with better morbidity profile
Karatag 2014,
case series, Turkey,
2013, abstract
[31]
NA
m
PNL 4.8 Fr
NA
Benefits: SFR
Harms: CG, BL,
Secondary outcomes:
DP, DHS
Other outcomes: DF
68 NA SFR: 98.5%
BL: 0.95 g/dl
CG 1: 1.4% + 3a: 4.2%
DP: 40 min
DHS: 27.5 h
DF: 108 s
NA
NR
NA
mPNL recommended as
alternative for medium renal
stones resistant to SWL
Desai 2013, case series,
India, recruitment
period NR, abstract
[30]NA
umPNL 12 Fr
NA
Benefits: SFR
Harms: CG, BL,
Secondary outcomes:
DHS
Other outcomes:
conversion to mPNL
due to bleeding
74 NA SFR: 92.4%
CG 1: 1 (1.4%)
BL: 1.6 1.0 g/dl
DHS: 1.2 0.8 d
Conversion to mPNL: 2 (2.7%)
NA
NR
FU: 1 mo
umPNL very safe and
efficacious for removal of
renal calculi up to 18 mm. Use
of disposables is minimal and
patient recovery fast
Desai 2013, case series,
India, recruitment
period NR
[8]NA
umPNL 13 Fr
NA
Benefits: SFR
Harms: CG, BL,
Secondary outcomes:
DHS
Other outcomes:
conversion to mPNL
due to bleeding
62 NA SFR: 86.66%
CG 1 (1.6%)
BL: 1.4 1.0 g/dl
DHS: 1.2 0.8 d
Conversion to mPNL: 2 (3.2%)
NA
NR
FU: 1 mo
umPNL is safe and easy to
learn but should be restricted
to medium stones (
<
2.0 cm)
Desai 2013, case series,
China, 2012
[20]NA
umPNL 11–13 Fr
NA
Benefits: ISFR, SFR,
Harms: CG, BL, US
Secondary outcomes:
DP, SP, DHS
Other outcomes:
Puncture locations
36 NA ISFR: 88.90%
SFR: 97.20%
CG 1: 3 (8.3%), CG 2: 2 (5.6%)
BL: 5.4 7.8 [0–21] g/dl
US: 2 (5.6%)
DP: 59.8 15.9 [30–90] min
SP: 1 (2.8%)
DHS: 3.0 0.9 [2–5] d
NA
NR
FU: 1 mo
Puncture locations:
Upper calyx: 7 (19.4%)
Middle calyx: 15 (41.7%)
Lower calyx: 14 (38.9%)
umPNL safe and efficacious
alternative for small-volume
disease with advantage of
high ISFR and final SFR and
lower complication rates.
Indications for umPNL are
moderate-sized stones as
alternative to ESWL or RIRS,
low pole stones not amenable
to RIRS, diverticular renal
stones, and stones refractory
to ESWL
Abdelhafez 2013,
case series, Germany,
2007–2011
[18]
Stone size
<
2 cm
mPNL 18 Fr
NA
Benefits: ISFR, SFR,
Harms: CG, BL, BT
Secondary outcomes:
DP, SP, DHS
98 NA Stone size
<
20 mm
ISFR: 90.8%
SFR: 98.9%
CG 1: 9 (9.2%), CG 2 (2.0%): 5 (5.1%), CG
3: 5 (5.1%)
BL: 1.3 0.9 g/dl
BT: 0 (0%)
DP: 69.2 34.8 min
SP: 8 (8.16%)
DHS: 3.7 1.2 d
Stone size 20 mm
ISFR: 76.7%
SFR: 94.6%
CG 1: 14 (15%), CG 2:
6 (6.5%), CG 3: 5 (5.4%)
BL: 1.7 1.2 g/dl
BT: 1 (1.1%)
DP: 97.4 48.7 min
SP: 17 (18.3%)
DHS: 4.3 1.5 d
0.007
0.1
0.2
0.015
NR
<
0.001
0.002
FU: 1 mo
Total SFR greater for small
stones. Most patients could be
rendered stone-free with
1 auxiliary procedure. The
high success rate and low rate
of higher grade complications
justify mPNL for large stones
Stone size 2 cm
93
Zimmermans 2012,
case series, Germany,
recruitment period NR,
abstract
[33]All patients, all stone sizes mPNL 18 Fr
NA
Benefits: ISFR
Harms: CG, BL, BT, VI
Secondary outcomes:
DP, SP
652 NA All stone sizes
ISFR: 93.6%
CG 2 [PN]: 49 (7.5%), CG 3
[BL]: 2 (0.3%) CG 4 [CI]: 1 (0.15%)
BL: 1 (0.15%) AVF, 2 (0.3%) recurrent
bleedings
BT: 9 (1.4%)
VI: 1 (0.15%) cerebral ischemia
DP: 65 31 min
SP: 172 (26.4%)
Subgroup: stones 500 mm
2
ISFR: 91.8%
CG 2 [PN]: 16 (8.7%)
BL: NR
BT: 2 (1.1%)
VI: NR
DP: 77 34 min
SP: 65 (35.5%)
NR
2/3 patients with recurrent
bleeding or AVF required
radiological intervention
mPNL is reliable and effective
technique for percutaneous
surgery. mPNL is effective and
equally safe for larger stone
burdens
Subgroup of stones 5 cm
2
183
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 2 2 0 – 2 3 5
229