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Double-sheath vacuum suction versus vacuum-assisted sheath minimally invasive percutaneous nephrolithotomy for management of large renal stones: single-center experience

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Abstract

Purpose

To compare double-sheath vacuum suction minimally invasive percutaneous nephrolithotomy (DS-mini-PCNL) with vacuum-assisted mini-PCNL (VS-mini-PCNL) and to better define the potential benefits of DS-mini-PCNL.

Methods

Between July 2019 and May 2020, 117 patients with large radiopaque renal stones underwent mini-PCNL. Of these, 63 underwent DS-mini-PCNL and 54 underwent VS-mini-PCNL. For VS-mini-PCNL, a F20 Y-shaped sheath was used and the oblique arm of the sheath was connected to the vacuum suction. For DS-mini-PCNL, the oblique arm of a F20 Y-shaped sheath (the outer sheath) and a F16 Y-shaped sheath (the inner sheath) was connected to the perfusion inflow and the vacuum suction, respectively. A 550-μm holmium–YAG laser was used for stone fragmentation.

Results

Compared with VS-mini-PCNL group, DS-mini-PCNL group had significantly shorter operative time (35.78 ± 7.77 min vs. 44.56 ± 13.19 min; P = 0.000) and significantly lower fever rate (1.6% vs. 11.1%; P = 0.048). It was not significantly different between the two groups despite the higher initial stone-free rate seen for DS-mini-PCNL group relative to VS-mini-PCNL group (87.7% vs. 81.5%, P = 0.346). Auxiliary procedure rates were 4.8% (three patients) in DS-mini-PCNL group and 16.7% (nine patients) in VS-mini-PCNL group, with a significant difference (P = 0.034). The difference in the final stone-free rate between the two groups was rendered insignificant (93.8% vs. 89.1%, P = 0.510).

Conclusions

DS-mini-PCNL is a safe and effective modality for large renal stones, which could increase the efficiency of stone extraction and decrease infectious complications compared with VS-mini-PCNL.

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Abbreviations

PCNL:

Percutaneous nephrolithotomy

mini-PCNL:

Minimally invasive percutaneous nephrolithotomy

DS-mini-PCNL:

Double-sheath vacuum suction mini-PCNL

VS-mini-PCNL:

Vacuum-assisted mini-PCNL

KUB:

Plain radiography of the kidneys, ureters, and bladder

US:

Ultrasonography

NCCT:

Non-contrast computed tomography

BMI:

Body mass index

URS:

Ureteroscopy lithotripsy

ESWL:

Extracorporeal shock wave lithotripsy

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Authors and Affiliations

  1. Department of Urology, Zhongnan Hospital of Wuhan University, Donghu Road #169, Wuchang District, Wuhan, 430071, Hubei, China

    Zhong-Hua Wu, Tong-Zu Liu, Xing-Huan Wang, Yong-Zhi Wang, Hang Zheng & Yin-Gao Zhang

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  1. Zhong-Hua Wu
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  2. Tong-Zu Liu
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  4. Yong-Zhi Wang
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  5. Hang Zheng
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  6. Yin-Gao Zhang
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Contributions

ZHW: project development, data collection and manuscript writing. TZL and XHW: project development, data management and manuscript editing. YZW: data collection and manuscript writing. HZ and YGZ: project development and manuscript editing.

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Correspondence to Tong-Zu Liu or Xing-Huan Wang.

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This retrospective study was conducted after receiving approval from the institutional review board.

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Wu, ZH., Liu, TZ., Wang, XH. et al. Double-sheath vacuum suction versus vacuum-assisted sheath minimally invasive percutaneous nephrolithotomy for management of large renal stones: single-center experience. World J Urol 39, 4255–4260 (2021). https://doi.org/10.1007/s00345-021-03731-4

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