Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

Introduction: Patients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on minipercutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). Methods: We conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15 mm or 10 mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one -session stone -free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. Results: We performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one -session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures ( P = 0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group ( P = 0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively ( P = 0.67). Conclusion: The efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. Level of proof: 3. (c) 2023 Elsevier Masson SAS. All rights reserved.