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Minimal-invasive PCNL (Mini-Perc)

Alternative oder Ersatz für konventionelle PCNL?

Minimally invasive PCNL (mini-perc)

Alternative treatment modality or replacement of conventional PCNL?

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Zusammenfassung

Steine des oberen Harntraktes stellten bislang die Domäne der extrakorporalen Stoßwellenlithotripsie (ESWL) dar. Bei einer Steinmasse >2 cm, Nierenkelchdivertikelsteinen und Steinen der unteren Nierenkelchgruppe sind die Ergebnisse der ESWL jedoch unbefriedigend. Die konventionelle perkutane Nephrolitholapaxie (PCNL) führt in diesen Fällen zwar zu einer deutlich höheren Steinfreiheitsrate, aber die Morbidität der konventionellen PCNL ist im Vergleich zur ESWL als deutlich höher zu bewerten. Neue Möglichkeiten ergeben sich seit Etablierung der minimal-invasiven PCNL (Mini-Perc). Die Erfahrungen bei mehreren hundert Behandlungen zeigen eine zur konventionellen PCNL vergleichbare Effektivität und eine zur ESWL vergleichbare Morbidität unabhängig von der Steingröße, -lokalisation und Alter des Patienten. Die Mini-Perc darf deshalb, entsprechende Expertise des Operateurs vorausgesetzt, als primäre Behandlungsmodalität bei Steinen des oberen Harntraktes mit einem Durchmesser >1 cm, größeren unteren Nierenkelchsteinen und Nierenkelchdivertikelsteinen als Alternative zur konventionellen PCNL bezeichnet werden.

Abstract

Extracorporeal shock wave lithotripsy (SWL) is the current treatment modality of choice for upper urinary tract calculi. For stones with a diameter >2 cm and in lower calyceal stones and diverticular stones, the stone-free rate of SWL is rather poor. In these cases, conventional percutaneous nephrolithotomy (PCNL) leads to an increased stone-free rate, but morbidity with conventional PCNL is significant higher than in SWL. With the invention of miniaturized nephroscopes (mini-perc), new treatment options are available. The experience based on hundreds of treatments using mini-perc show comparable results of mini-perc to conventional PCNL and a complication rate comparable to that for SWL. These favorable results are independent of stone size, stone location, and patient age. In summary, mini-perc can be recommended as a primary approach to stones of the upper urinary tract exceeding 1 cm, larger lower-pole stones, and calyceal diverticular stones. Mini-perc can be regarded as an alternative treatment modality to conventional PCNL.

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Authors and Affiliations

  1. Klinik für Urologie, Krankenhaus St. Trudpert, Wolfsbergallee 50, 75175, Pforzheim, Deutschland

    S. Lahme, V. Zimmermanns & A. Hochmuth

  2. Klinik für Urologie, Klinikum, Pirna, Deutschland

    V. Janitzki

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  1. S. Lahme
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  2. V. Zimmermanns
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  3. A. Hochmuth
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  4. V. Janitzki
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Correspondence to S. Lahme.

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Lahme, S., Zimmermanns, V., Hochmuth, A. et al. Minimal-invasive PCNL (Mini-Perc). Urologe 47, 563–568 (2008). https://doi.org/10.1007/s00120-008-1708-3

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  • DOI: https://doi.org/10.1007/s00120-008-1708-3

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