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…