Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study

Abstract Objective To compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL. Patients and Methods Adult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients, 90 renal units) and prospectively compared versus staged-Mini-PNL (55 patients, 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy. A semirigid ureteroscope (8.5/11.5Fr) was used. Mann-Whitney, Student-t, Chi-square or Fisher-exact tests were used as appropriate. Results Both groups were comparable in characteristics of stones and patients. Stone burden was 3.36±1.61 vs 3.38±1.18 cm 2 in BSS-Mini-PNL vs staged-Mini-PNL; respectively. Staghorn stones were present in 13.3% vs 8.2% in BSS-Mini-PNL vs staged-Mini-PNL; respectively. There was no significant difference in the number of required tracts (1.34±0.6 vs 1.25±0.51 tract/renal unit) as well as the rate of tubeless Mini-PNL (81.1% vs 85.5%) or SFR (90% vs 92.7%) in BSS-Mini-PNL vs staged-Mini-PNL; respectively. BSS-Mini-PNL had significantly shorter operative time (126.22±37.2 vs 169.63±61.28 min), shorter hospital stay (2[1-8] vs 4[2-16] days) and higher hemoglobin loss (1.1[0.1-2.8] vs 0.5[0.1-2.17] gm/d) than staged-Mini-PNL. The complications profile (17.8% vs 13.6%) and rate of blood transfusion (4.4% vs 3.6%) were comparable in BSS-Mini-PNL vs staged-Mini-PNL; respectively without significant difference. Conclusion BSS-Mini-PNL is comparable to staged-PNL as regard SFR and complications according to the selection criteria of the present study. However, BSS-Mini-PNL is associated with significant reduction in the cumulative operative time and hospital stay which are reflected on the overall cost.