Minimally invasive percutaneous nephrolithotomy: The chinese approach

Abstract

The Chinese approach of minimally invasive percutaneous nephrolithotomy (Chinese MPCNL) is mostly similar to standard percutaneous nephrolithotomy, but there are some differences. The fi rst difference is tract size and dilator; only 14�18-Fr percutaneous working tracts were used during the procedure. We also modi fi ed fascial dilators, a dilator with marks on the lateral view to indicate how deeply it had been introduced, without the use of fl uoroscopy, thus decreasing the X-ray exposure for both the operators and patients. The second difference is that endoscope, semirigid ureteroscope, and pediatric nephroscope replaced the rigid nephroscope; with the small sheath, it is normally possible to inspect the renal pelvis, upper and lower alyx, and proximal ureter up to L4, which decreased the risk of bleeding and increased the stone-free rate. The third difference is the irrigation pump, which we had modi fi ed. A specially designed endoscopic pump could provide an impulse wave pressurized irrigation to facilitate fl ushing out of stone fragments, which could shorten operative time. Over the past 19 years, 10,452 patients with all kinds of upper tract urinary calculi were treated with Chinese MPCNL, which has a high stone-free rate and lower complications. It was proved to be effective and safe.