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AbstractBackground and Purpose:Percutaneous nephrolithotomy (PCNL) using a small tract is controversial, and its indication is considered limited. In our center, however, we have performed Chinese minimally invasive PCNL regularly for managing upper-tract calculi. We report our experience.Patients and Methods:Our technique is not just about using smaller instruments and tracts. Our overall approach is different from the standard PCNL. We preferred a middle caliceal puncture via the 11th rib space and also relied mainly on a strong irrigant current for stone fragment removal. We reviewed and analyzed the prospectively collected database on patients who underwent minimally invasive (MPCNL) from 2001 to 2005.Results:A total of 4760 MPCNL procedures were performed in 3610 kidneys. There were 1240 staghorn stones and 85 ureteral stones. There were 14 transplanted kidneys and 27 cases of horseshoe kidneys. The average operative time was 78 minutes. The stone-free rate at postoperative day 2 was 89%. The major complication rate was 0.86%.Conclusion:Our experience with the Chinese MPCNL shows that it is safe and effective for managing all kinds of upper-tract calculi. [ABSTRACT FROM AUTHOR]

ObjectiveHigh renal pelvic pressure brings systemic absorption of irrigation fluid containing bacteria or endotoxins, which leads to postoperative fever. We inspected the renal pelvic pressure (RPP) in vivoduring minimally invasive percutaneous nephrolithotomy (MPCNL) to investigate whether a 14- to 18-French percutaneous tract and perfusion would bring high RPP and postoperative fever.Patients and MethodsBetween July 2005 and December 2007, 80 patients were selected for RPP measurement during MPCNL. The RPP was measured by a baroceptor connected to the open-ended ureteric catheter, which was indwelling retrogradely in the renal pelvic. A computer recorded the RPP each second, and all the data were evaluated statistically with SPSS 12.0 software.ResultsDuring MPCNL with 14-, 16-, 18-, and double-16-French percutaneous tracts, the mean RPP was 24.55, 16.49, 11.22, and 6.64 mm Hg, respectively. Logistical analysis suggested that postoperative fever did not correlate to gender (P 0.195), age (P 0.641), urinary tract infection (P 0.663), white blood cell ≥ 10 × 109/L in routine postoperative blood examination (P 0.751), or an occurrence of renal pelvic pressure ≥ 30 mm Hg in the operation (P 0.662), although infection calculi (P 0.000), percutaneous tract (P 0.029), mean RPP (P 0.036), mean RPP ≥ 20 mm Hg (P 0.013), accumulated time of RPP ≥ 30 mm Hg (P 0.010), and RPP ≥ 30 mm Hg longer than 50 s (P 0.024) may contribute a postoperative fever.ConclusionRenal pelvic pressure generally remains lower than the backflow level (30 mm Hg) during MPCNL via a 14- to 18-French percutaneous tract. Any factors that brought about poor drainage would result in temporarily elevated RPP greater than 30 mm Hg, and many such occurrences of high pressure would have an accumulating effect, which means enough backflow to cause bacteremia and postoperative fever. [ABSTRACT FROM AUTHOR]