Mini-percutaneous nephrolithotomy: Is smaller better for kidney stones in patients with neurogenic bladder?

Patients with neurologic bladder are at an increased risk for urolithiasis, and currently, data on mini-percutaneous nephrolithotomy in this population are limited. Our objective was to compare mini (15F)-percutaneous nephrolithotomy, standard (24F)-PCNL and flexible ureteroscopy in terms of efficacy and safety in treatment of kidney stones in patients with neurogenic lower urinary tract dysfunction (NLUTD). We conducted a retrospective monocentric study in our neuro-urological referral centre. All consecutive patients with NLUTD and a cumulative size of renal calculi greater than 15mm or 10mm in the lower calyx, who had extraction surgery between 2005 and 2020, were included. The primary endpoint was the one-session stone-free rate (SFR) at 3 months on a CT scan. The secondary endpoints were complication (Clavien-Dindo grading system), operative time, blood loss and length of hospital stay. We performed 76 standard PCNL (sPCNL), 46 flexible ureteroscopy lithotripsy (fURL) and 25 miniaturized PCNL (mPCNL). The one-session SFR was 37.5% for the mPCNL group, 38.2% for the sPCNL group and 37% for the fURL group with no significant difference between the three procedures (P=0.99). Early complications, blood loss and transfusion rates were lower in the mPCNL group than in the sPCNL group (P=0.047) and comparable to fURL group. The final SFRs after a second intervention for mPCNL, sPCNL and fURL were 48%, 61.8% and 63%, respectively (P=0.67). The efficacy of mPCNL in patients with NLUTD was not different from other techniques, but a significantly lower rate of complications than sPCNL was observed. 3. Les patients atteints de vessie neurologique présentent un risque plus important de calculs urinaires et de complications qui leurs sont liées. Actuellement, les données sur la mini-néphrolithotomie percutanée (mini-NLPC) dans cette population sont limitées. L’objectif était de comparer l’efficacité et la morbidité de la mini-NLPC à la NLPC et à l’urétéro-rénoscopie souple (URSS) pour le traitement des calculs rénaux de plus de 15mm chez les patients atteints de vessie neurologique. Étude retrospective, monocentrique, menée dans un centre de neuro-urologie de référence entre 2005 et 2020. Les patients avec vessie neurologique, porteurs de calculs rénaux>15mm ou > 10mm caliciel inférieur, ayant eu une chirurgie d’extraction lithiasique, étaient inclus. L’efficacité était définie par le taux de sans fragment (SFR) sur le scanner de contrôle à 3 mois, et les complicat