Korean J Radiol.  2006 Mar;7(1):50-56. 10.3348/kjr.2006.7.1.50.

The "Mini-Perc" Technique of Percutaneous Nephrolithotomy with a 14-Fr Peel-away Sheath: 3-year Results in 72 Patients

• Sung YM
• Choo SW
• Jeon SS
• Shin SW
• Park KB
• Do YS

• KMID: 753916
• DOI: http://doi.org/10.3348/kjr.2006.7.1.50

Abstract

OBJECTIVE
To assess the efficacy and safety of a "mini-perc" technique of percutaneous nephrolithotomy using a 14-Fr peel-away sheath for the removal of pyelocaliceal stones, and to determine appropriate inclusion criteria. MATERIALS AND METHODS: From July 1999 to June 2002, the medical records and radiographic images of 72 patients who underwent the "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath, were reviewed to determine clinical history, stone characteristics, immediate stone free rate, final stone free rate after additional procedures, complications, and hospital stay. We also analyzed the effect of the longest stone diameter, the cumulative longest diameter of stones, the cumulative stone burden, and the stone density on the immediate stone free rate using a Fisher exact test. RESULTS: The only major complication, arterial bleeding, occurred in a patient with Child A liver cirrhosis and was successfully treated by embolization with coils and a gelatin sponge. The immediate stone free rate was 80.6 %, which was significantly influenced by stone diameter but not stone density. The mean hospital stay after the procedure was 3.97 days. CONCLUSION: The "mini-perc" technique of percutaneous nephrolithotomy, which uses the 14-Fr peel-away sheath, is a safe and effective modality for treating renal calculi.

Keyword

Genitourinary system, calculi; Kidney, calculi; Kidney, interventional procedure

MeSH Terms

Nephrostomy, Percutaneous/adverse effects/*instrumentation
Middle Aged
Male
Length of Stay
Kidney Calculi/*therapy
Infant
Humans
Follow-Up Studies
Female
Child, Preschool
Child
Aged
Adult
Adolescent

Figure

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  Fig. 1 A 17-month-old boy with upper pole calyceal and pelvic stones in the right kidney. A-C. Abdominal radiograph and non-enhanced helical CT scans (120 kVp, 160 mA, 2.5 mm collimation) show upper pole calyceal and pelvic stones in the right kidney. D. Nephrostomy was created toward the postero-inferior aspect of the renal stones. E. Intraoperative abdominal radiograph demonstrates a safety guide wire (arrows) and a working guide wire (arrowheads) inserted on prone position. F. One month after the procedure, renal stones are shown successfully removed on abdominal radiograph.

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  Fig. 2 A 14-Fr peel-away sheath for percutaneous access.

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  Fig. 3 A 65-year-old man with massive hematuria after the "mini-perc", who was diagnosed with Child A liver cirrhosis. A. Right renal arteriogram shows suspicious contrast extravasation at the lower pole of the kidney. B. Superselective renal arteriogram revealed a contrast extravasation from the arcuate artery of the right kidney. C. After embolization with a coil and gelatin sponge, no further bleeding was seen.

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