Mini-PNCL vs fURS in Management of Nephrolithiasis
Nephrolithiasis, Kidney Stone
About this trial
This is an interventional treatment trial for Nephrolithiasis
Eligibility Criteria
Inclusion Criteria:
- Male and female subjects over 18 years of age at the time of enrollment.
- Patients referred with single kidney stones of 10-20 mm in its largest diameter, or multiple stones involving a single calyx.
- Written informed consent to participate in the study
- Ability to comply with the requirements of the study procedures
Exclusion Criteria:
- Congenital anatomic anomalies of the kidney, ureters or bladder.
- Previous ipsilateral renal surgery within past five years.
- Patients with ipsilateral distal ureteral stones or stricture.
- Stone size > 20 mL or multiple kidney stones in different calyces.
- Previous SWL treatment for the same stone.
- Patients presented with a previously inserted ipsilateral ureteral stent.
- Participants with active urinary tract infection until appropriately treated
- Uncorrected coagulopathy (anticoagulants or blood thinners which cannot be withheld before surgery).
- Pregnancy or morbid obesity
- Participants with preexisting conditions, which, in the opinion of the investigator, interfere with the conduct of the study.
- Participants who are uncooperative or cannot follow instructions.
- Participants who lack the capacity to provide free and informed written consent.
- Patients with solitary kidney.
Sites / Locations
- Thunder Bay Regional Health Sciences Centre/Thunder Bay Regional Health Research InstituteRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Flexible ureteroscopy (fURS)
Mini-percutaneous nephrolithotomy (mini-PCNL)
Retrograde intrarenal surgery (RIRS) has gained much popularity especially when the role of SWL, in management of LPS, has been significantly diminished in the few last years5. RIRS is dependent mainly on flexible ureteroscopy (fURS). fURS increases the quality and performance of upper urinary tract exploration, allowing for the treatment of the majority of stones at all sites. Moreover, it is associated with no risk of renal parenchymal injuries and a very low risk of bleeding.
PCNL has regained popularity thanks to the possibility of using reduced calibers and modern technology, which has reduced the complications without compromising the stone clearance, and more efficient intracorporeal lithotripter modalities. However, PCNL is still a challenging surgical technique and can be associated with significant complications that may compromise its efficacy. In the present time, we have available calibers ranging from 4.8 to 30 French. Many reports advocate that morbidity after PCNL may be reduced by recent modifications, such as mini-PCNL (miniperc). One meta-analysis of mini-PCNL and conventional PCNL demonstrated that mini-PCNL had a greater safety profile with similar stone free rates (SFRs)4