, Volume 47, Issue 2, pp 207–214 | Cite as

Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study

  • Mohammed S. ElSheemyEmail author
  • Akram A. Elmarakbi
  • Mohammed Hytham
  • Hamdy Ibrahim
  • Sanjay Khadgi
  • Ahmed M. Al-Kandari
Original Paper


To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann–Whitney, Chi square or Fisher’s exact tests as appropriate in addition to logistic regression analysis. P < 0.05 was considered statistically significant. Mini-PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm2; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p < 0.001). SFR was significantly lower in Mini-PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm2), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm2), but not with single stones or stone burden ≤ 2 cm2.


Mini-percutaneous nephrolithotomy Mini-PNL Miniperc Percutaneous nephrolithotomy Renal stones 



Plain abdominal radiography


Mini-percutaneous nephrolithotomy


Non-contrast computed tomography scan


Percutaneous nephrostomy


Percutaneous nephrolithotomy


Stone free rate


Standard percutaneous nephrolithotomy


Extracorporeal shockwave lithotripsy


Abdominal ultrasonography


Authors’ contribution

ElSheemy: Protocol/project development, data collection and management, data analysis, manuscript writing/editing. Elmarakbi: Protocol/project development, data collection and management. Hytham: Protocol/project development, data collection. Hamdy Ibrahim: Protocol/project development, data collection. Khadgi: Protocol/project development, data collection and management. Al-Kandari: Protocol/project development, data collection and management.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. No funding source or industrial links and affiliations.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethical committee.

Informed consent

Informed consent was obtained from all the individual participants included in the study.


  1. 1.
    Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Tepeler A, Thomas K, Dabestani S, Drake T, Grivas N, Ruhayel Y (2017) EAU guidelines on urolithiasis [online]. Accessed date 24 Mar 2017
  2. 2.
    Yamaguchi A, Skolarikos A, Buchholz NP, Chomón GB, Grasso M, Saba P, Nakada S, de la Rosette J; Clinical Research Office Of The Endourological Society Percutaneous Nephrolithotomy Study Group (2011). Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol Jun;25(6):933–939. (Epub 2011 May 13)CrossRefGoogle Scholar
  3. 3.
    Jackman SV, Hedican SP, Peters CA, Docimo SG (1998) Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique. Urology 52(4):697–701CrossRefGoogle Scholar
  4. 4.
    Lahme S, Bichler KH, Strohmaier WL, Gotz T (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40(6):619–624CrossRefGoogle Scholar
  5. 5.
    Giusti G, Piccinelli A, Taverna G, Benetti A, Pasini L, Corinti M, Teppa A, Zandegiacomo De Zorzi S, Graziotti P (2007) Miniperc?. No, thank you! Eur Urol 51(3):810–815. CrossRefGoogle Scholar
  6. 6.
    Knoll T, Wezel F, Michel MS, Honeck P, Wendt-Nordahl G (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24(7):1075–1079. CrossRefGoogle Scholar
  7. 7.
    Li L, Gao X, Yang M, Li J, Zhang H, Xu W, Lin Z (2010) Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study. Urology 75(1):56–61. CrossRefGoogle Scholar
  8. 8.
    Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y (2010) Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol 24(10):1579–1582. CrossRefGoogle Scholar
  9. 9.
    Zhong W, Zeng G, Wu W, Chen W, Wu K (2011) Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res 39(2):117–122. CrossRefGoogle Scholar
  10. 10.
    Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M (2011) Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 108(6):896–900. Google Scholar
  11. 11.
    Song L, Chen Z, Liu T, Zhong J, Qin W, Guo S, Peng Z, Hu M, Du C, Zhu L, Yao L, Yang Z, Huang J, Xie D (2011) The application of a patented system to minimally invasive percutaneous nephrolithotomy. J Endourol 25(8):1281–1286. CrossRefGoogle Scholar
  12. 12.
    Xu S, Shi H, Zhu J, Wang Y, Cao Y, Li K, Wang Y, Sun Z, Xia S (2014) A prospective comparative study of haemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy. World J Urol 32(5):1275–1280. CrossRefGoogle Scholar
  13. 13.
    Zhu W, Liu Y, Liu L, Lei M, Yuan J, Wan SP, Zeng G (2015) Minimally invasive versus standard percutaneous nephrolithotomy: a meta-analysis. Urolithiasis Nov 43(6):563–70. CrossRefGoogle Scholar
  14. 14.
    Abdelhafez MF, Wendt-Nordahl G, Kruck S, Mager R, Stenzl A, Knoll T, Schilling D (2016) Minimally invasive versus conventional large-bore percutaneous nephrolithotomy in the treatment of large-sized renal calculi: Surgeon’s preference? Scand J Urol Jun 50(3):212–215. (Epub 2016 Mar 24)CrossRefGoogle Scholar
  15. 15.
    Sakr A, Salem E, Kamel M, Desoky E, Ragab A, Omran M, Fawzi A, Shahin A (2017) Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience. Urolithiasis Feb 22. (Epub ahead of print)Google Scholar
  16. 16.
    Hinman F, Redewill FH (1926) Pyelovenous back flow. JAMA 87:1287–1288CrossRefGoogle Scholar
  17. 17.
    Zhong W, Zeng G, Wu K, Li X, Chen W, Yang H (2008) Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvicpressure and postoperative fever? J Endourol 22(9):2147–2151. CrossRefGoogle Scholar
  18. 18.
    Stenberg A, Bohman SO, Morsing P, Müller-Suur C, Olsen L, Persson AE (1988) Back-leak of pelvic urine to the bloodstream. Acta Physiol Scand Oct 134(2):223–234CrossRefGoogle Scholar
  19. 19.
    Troxel SA, Low RK (2002) Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol Oct 168:1348–1351CrossRefGoogle Scholar
  20. 20.
    Abdelhafez MF, Amend B, Bedke J et al (2013) Minimally invasive percutaneous nephrolithotomy: a comparative study of the management of small and large renal stones. Urology 81(2):241–245. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mohammed S. ElSheemy
    • 1
    Email author
  • Akram A. Elmarakbi
    • 2
  • Mohammed Hytham
    • 1
  • Hamdy Ibrahim
    • 3
  • Sanjay Khadgi
    • 4
  • Ahmed M. Al-Kandari
    • 5
  1. 1.Urology department, Kasr Al-Ainy HospitalsCairo UniversityCairoEgypt
  2. 2.Urology DepartmentBani Swaif UniversityBani SwaifEgypt
  3. 3.Urology DepartmentFayoum UniversityFayoumEgypt
  4. 4.Vayodah and Venus International HospitalsKathmanduNepal
  5. 5.Urology DepartmentKuwait UniversityKuwait CityKuwait

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