Mini PCNL versus Standard PCNL
Manoj J. Monga, MD, FACS, Professor and Chair of Urology at the University of California, San Diego, compares mini percutaneous nephrolithotomy (mini PCNL) for renal stone removal to standard percutaneous nephrolithotomy (PCNL). He begins by looking at who needs a PCNL, explaining that he typically performs them on patients with a stone larger than 15mm, but that he also sometimes performs PCNL on stones when there are anatomical considerations that would make it difficult to get to the stone ureteroscopically. Dr. Monga notes that PCNL has the best outcomes and results in the best quality of life of any stone removal technique. He then poses the question: Why not treat every stone with PCNL? The answer, of course, he says, is because 4/1000 patients die from PCNL due to sepsis. Dr. Monga then moves on to discuss mini PCNL, noting that it was originally assumed to potentially be safer than PCNL, but that a 2001 study showed there was no advantage. He also observes that the smaller sheath used in mini PCNL actually increases the risk of infectious complications, and that outcomes are worse and operating room time is longer with mini PCNL compared to standard. However, Dr. Monga notes, there does appear to be a lower risk for bleeding and fewer transfusions, which might result in less kidney volume loss.
Read More