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Inicio Actas Urológicas Españolas (English Edition) Miniperc and retrograde intrarenal surgery: When and how?
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Vol. 39. Issue 7.
Pages 442-450 (September 2015)
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Vol. 39. Issue 7.
Pages 442-450 (September 2015)
Review article
Miniperc and retrograde intrarenal surgery: When and how?
Miniperc y Cirugía Retrógrada Intrarrenal: ¿cuándo y cómo?
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166
F. Ramón de Fataa, K. Haunerb, G. Andrésa, J.C. Anguloa,
Corresponding author
jangulo@futurnet.es

Corresponding author.
, M. Straubb
a Servicio de Urología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
b Urologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Múnich, Alemania, Germany
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Tables (5)
Table 1. Indications of retrograde intrarenal surgery (RIRS).
Table 2. Indications for minimally invasive percutaneous nephrolithotomy (Mini-PNL).
Table 3. Indications of percutaneous approach without nephrostomy (Tubeless).
Table 4. Main series published with minimally invasive percutaneous nephrolithotomy (Mini-PNL).
Table 5. Principales series publicadas de Cirugía Retrógrada Intrarrenal (CRIR).
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Abstract
Context

Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) are consolidated procedures for the treatment of kidney stones; however, their primary weak points are the lower efficacy of ESWL, especially for lower calyx stones, and the morbidity of PCNL resulting from the creation and dilation of the percutaneous trajectory. The increasing miniaturization of percutaneous surgery instrumentation and the development of retrograde intrarenal surgery (RIRS) are recent innovations.

Acquisition of evidence

A structured nonsystematic review was conducted through a literature search of articles published between 1997 and 2013, using the terms kidney stones, miniperc, mini-PCNL, RIRS and flexible ureteroscopy in the PubMed, Google Scholar and Scopus databases.

Summary of the evidence

RIRS requires greater surgical time, several procedures for voluminous stones and higher hospital costs, due in part to the relative fragility of the instruments. On the other hand, miniperc requires a longer hospital stay, an increased need for postoperative analgesia and a greater reduction in hemoglobin levels, although these do not translate into an increased rate of transfusions.

Conclusions

The current treatment of kidney stones uses minimally invasive procedures such as miniperc and RIRS. The two procedures are equivalent in terms of efficacy (stone clearance) and are associated with minimal complications. Comparative prospective studies are necessary to determine the position of each of these techniques in the treatment of kidney stones. In our experience, the two techniques are complementary and should be part of the current urological therapeutic arsenal.

Keywords:
Kidney stone
Retrograde intrarenal surgery
Minipercutaneous nephrolithotomy
Indications
Technique
Resumen
Contexto

La Litotricia Extracorpórea por Ondas de Choque (LEOCH) y la Nefrolitotomía Percutánea (NLP) son procedimientos consolidados en el tratamiento de la litiasis renal, pero sus principales puntos débiles son la menor eficacia de la LEOCH, especialmente en litiasis de cáliz inferior, y la morbilidad de la NLP, derivada de la creación-dilatación del trayecto percutáneo. La creciente miniaturización del instrumental de cirugía percutánea, y el desarrollo de la cirugía retrógrada intrarrenal (CRIR) son innovaciones recientes.

Adquisición de evidencia

Se ha llevado a cabo una revisión estructurada no sistemática, a través de una búsqueda bibliográfica de los artículos publicados entre 1997 y 2013, utilizando los términos litiasis renal, miniperc, mini-NLP, CRIR y ureteroscopia flexible en las bases de datos PubMed, Google Scholar y Scopus.

Síntesis de evidencia

La CRIR consume mayor tiempo operatorio, precisa varios procedimientos en litiasis voluminosas e implica mayor coste hospitalario, derivado en parte de la relativa fragilidad del instrumental. Por otro lado, miniperc, precisa una estancia hospitalaria más prolongada, mayor necesidad de analgesia postoperatoria y mayor descenso de hemoglobina, aunque sin traducirse en una mayor tasa de transfusión.

Conclusiones

El tratamiento contemporáneo de la litiasis renal emplea procedimientos mínimamente invasivos como miniperc y CRIR. Ambos son equivalentes en términos de eficacia (aclaramiento litiásico) y se asocian con mínimas complicaciones. Son necesarios estudios comparativos prospectivos que determinen la posición de cada una de estas técnicas en el tratamiento de la litiasis renal. En nuestra experiencia ambas resultan complementarias y deben formar parte del arsenal terapéutico actual urológico.

Palabras clave:
Litiasis renal
Cirugía retrógrada intrarrenal
Mini-nefrolitotomía percutánea
Indicaciones
Técnica

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