Introduction: Vacuum-assisted access sheaths recently have been introduced to help overcome limitations of traditional miniaturized percutaneous nephrolithotomy (PCNL) systems including difficult stone retrieval and limited irrigation. The simultaneous suction property with continuous irrigation throughout the case enhances visibility and precludes the need for additional stone retrieval devices.
Methods: Prospectively collected data was reviewed from the Registry for Stones of the Kidney and Ureter (ReSKU) from consecutive vacuum assisted mini PCNL (vmPCNL) procedures performed between May 2019 and August 2021. Demographics, clinical characteristics as well as operative and post-operative outcomes were reviewed.
Results: 45 patient underwent vmPCNL during the study period, of whom 31 were female (68.9%). The median age was 59.6 years (IQR: 47.5-67.4). Seventeen (37.8%) patients had an ASA score of 3 or greater. Most patients (62.2%) had a stone burden >20 mm and the median total operative time was 155 min (IQR: 137-179). Ultrasound guidance was used for the majority of percutaneous access (93.3%) and the lower pole was the preferred location to enter the collecting system in 24 (53.3%) cases.Visual clearance of stone fragments was achieved in 86.7% (39/45) of cases. 51.5% of patients had a ureteral stent and 44.4% had a nephrostomy tube placed at the end of the procedure. Post-operative complications (Clavien–Dindo score =1) were observed in 6/45 (13.3%) cases; same day discharge was achieved in 22.2% (10/45) of cases, and 40% (18/45) were discharged on post-operative day (POD) 1
Conclusions: vmPCNL is a safe and efficient approach for management of patients with a large stone burden. It may help facilitate same day discharge and larger future studies will consolidate our knowledge on the role of this technique in the urologist’s armamentarium.