Mini-Perc for Renal Stones-A Single Center Experience and Literature Review.

AIM: The aim of this study was to analyze the outcomes of miniaturized nephrolithotomy (mini-perc) in the management of renal stones with a diameter smaller than 20 mm. MATERIALS AND METHODS: We retrospectively reviewed the records of 102 patients who underwent mini-perc between March 2015 and March 2020 in our department. The primary objective was the stone-free rate, but we also analyzed the retreatment rate, complications, hospital stay, operative time and reduction in hemoglobin level. All these patients had this technique as their first-line treatment, in a prone position, using a 16 Fr sheath size. Data were compared to a series of patients from the literature, treated with conventional PCNL. RESULTS: The patients had calculus limited to either a single calyx or just extending to the renal pelvis, and stone size was less than 20 mm in its maximal dimension. The intrarenal stone location was in the upper calyx in 7 cases, middle calyx in 20 cases and lower calyx in 46 cases, and there were 29 patients with renal pelvis stone. The male to female ratio was 1.5:1, and the median age was 48.4 years. The average stone size was 17.4 mm in diameter (ranging between 9 and 20 mm) and all cases underwent Ho-YaG laser lithotripsy, ballistic energy and combined ultrasonic and ballistic lithotripsy. At the end of the procedure, an antegrade double J stent was placed under fluoroscopy for a maximum of 2 weeks in 42 cases, while 9 cases needed a nephrostomy tube 12-14 F. A total of 51 cases were totally tubeless. Our median operative time was 61 min (ranging from 35 to 75 min). The median hospitalization stay was 3.8 days. The stone free rate was 90.1% after one procedure, only nine (8.8%) cases needed a "second look" flexible ureteroscopy, and the final stone-free rate was 98% (absence of detectable calculi on ultrasound, KUB or non-contrast CT scan). The overall complication rate was 6.86% (Clavien classification I-57.14%; II-28.5%; III-14.2%), while no Clavien IV or V complications were reported. No patient required a blood transfusion, and mean hemoglobin loss was 0.81 mg/dL. Overall, our results are better than similar data for conventional PCNL in the literature. CONCLUSIONS: The "mini-perc" technique is an effective procedure for the treatment of the renal lithiasis that is less or equal to 2 cm. The results demonstrated that this minimally invasive technique is associated with a higher stone-free rate and minimal complications.

Innovative technique in nonmuscle invasive bladder cancer-bipolar plasma vaporization.

OBJECTIVES: To evaluate the efficacy and safety of a newly introduced endoscopic technique in the treatment of nonmuscle-invasive bladder tumors (NMIBT), the bipolar plasma vaporization of bladder tumors (BPV-BT), and to compare it with monopolar transurethral resection of bladder tumors (TURBT). METHODS: A total of 120 patients with at least one bladder tumor larger than 3 cm were enrolled in the study and randomized for BPV-BT and TURBT. Resection biopsy followed by tumor plasma vaporization and biopsies of the tumoral bed were performed in the 60 cases of the BPV-BT arm. All NMIBT patients underwent monopolar Re-TURBT 4 weeks after the initial procedure. RESULTS: The mean operative time and postoperative hemoglobin decrease were significantly improved for BPV-BT compared with TURBT (21.4 minutes vs 32.7 minutes and 0.3 g/dL vs 0.9 g/dL). The perioperative complications were more frequent in the TURBT arm. The mean catheterization period and hospital stay were significantly shorter in the BPV-BT series (2.5 vs 3.5 days and 3.5 vs 4.5 days). During follow-up, the overall residual tumors' rate at Re-TURBT was 9.3% in the BPVBT group vs 20.8% in the TURBT group. Primary site recurrences occurred in 7.4% vs 17% of the cases, whereas in patients with initial multiple tumors, the recurrence rate was 9.7% vs 25%. CONCLUSIONS: BPV-BT seems to represent a promising endoscopic treatment alternative for NMIBT patients, with good efficacy, reduced morbidity, fast postoperative recovery, and significantly decreased residual tumors' rate by compared with TURBT.

Transurethral resection (TUR) in saline plasma vaporization of the prostate vs standard TUR of the prostate: 'the better choice' in benign prostatic hyperplasia?

OBJECTIVE: To evaluate the efficiency, safety and short-term outcome of transurethral resection in saline plasma vaporization of the prostate (TURis-PVP), and to compare it to the standard TUR of the prostate (TURP). PATIENTS AND METHODS: In all, 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), with a maximum urinary flow rate (Q(max) ) of <10 mL/s, an International Prostate Symptom Score (IPSS) of >19 and prostate volume of 30-80 mL were enrolled in this prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months after surgery by IPSS, health-related quality of life (HRQL) score, Q(max) and postvoid residual urine volume (PVR). RESULTS: Patients from both series had similar preoperative characteristics. TURis-PVP and TURP were successfully performed in all cases (75 and 80, respectively). The operative duration, catheterization period and hospital stay were significantly shorter for TURis-PVP patients at 35.1 vs 50.4 min, 23.8 vs 71.2 and 47.6 vs 93.1 h, respectively (all P < 0.05). At the 1, 3 and 6 months follow-ups, improvements in the variables measured were better in the TURis-PVP group: the IPSS was 4.4 vs 8.3 and the Q(max) was 22.7 vs 20.5 mL/s at 1 month; the IPSS was 4.8 vs 8.6 and the Q(max) was 22.3 vs 20.0 mL/s at 3 months; and the IPSS was 5 vs 9.1 and the Q(max) was 21.8 vs 19.3 mL/s at 6 months (All P < 0.05). CONCLUSIONS: TURis-PVP represents a valuable endoscopic treatment alternative for patients with BPE, with superior efficacy, short-term results and complication rates compared with monopolar TURP.