PCNL my way – UMPCNL
Mordechai Duvdevani, MD
Hadassah Hebrew University Hospital – Jerusalem
Israel
Treatment options
Treatment options
• Shock wave lithotripsy
• Ureterorenoscopy
• Percutaneous nephrolithotomy
lowest
Highest
EAU guidelines
PCNL: Complications
• Infection/sepsis
• Bleeding
– Requiring transfusion < 2%
• Bowel injury
• Hydro/pneumothorax
• AVM
PCNL is a very effective surgery
• However, do we really need that?
PCNL
• Is there a way to make the percutaneous
approach more gentle?
PCNL: Lower Calyx • Miniaturization of endoscopes
– Mini
– Ultramini
– Micro
Terminology
Methods Sheath Nefroscope
PCNL 24-30F 26F
Mini PCNL 14-20F 12F
Ultra-Mini PCNL 11-14F
Tract size • No real scientific reason for choosing 30F as the
standard size for original PCNL
Tract size
• Large tract -advantages:
– Shorter operation
– Better stone handling
and clearance
– Better irrigation
– Better vision
– Less pressure
Tract size
• Large tract - disadvantages:
– Inappropriate to small clayceal systems (young kids)
– Increased bleeding
– Kidney function???
Tract size
• How small is 14f ?
– 14f / 30f is not just x2!
Tract size • Area of a Circle:
(15f)2
4.6
Tract size
Tract size
Tract size
UMPCNL - Hadassah
• 71 cases
• Average OR time – 105 min.
• 11 – staghorn stones
• Average stone burden 572 mm2
• 92% SF
– Bloodless
– 1 sepsis (1.4%)
• 5 cases
• Average stone burden 706 mm2
• Average laser time – 756 sec (12.6 min)
–4min – 23.8 min
Upper tract TCC
• 76y lady
• Solitary 2cm upper tract TCC
• Pathology – LG, cytology - negative
• Located at the renal pelvis towards lower calyx
• 3X RIRS for tumor ablation
• Tumor base could not be fulgurated with laser
due to narrow angle
Upper tract TCC
• Percutaneous tumor ablation
• 14F tract
• Thulium laser ablation
• Totally tubeless
Upper tract TCC
Upper tract TCC
Upper tract TCC
Upper tract TCC
Upper tract TCC
• Patient was discharged POD 2
• Clear urine
• Normal creatinine
Conclusions
Conclusions
Conclusions
Conclusions
Conclusions
Conclusions
Thank you…