TY - JOUR T1 - Comparison of Pneumatic Lithotripter and Holmium-YAG Laser Lithotripter in Supine Mini Percutaneous Nephrolithotomy: A Single-Centre Experience TT - Supin Mini Perkütan Nefrolitotomide Pnömatik litotriptör ile Holmium-YAG Lazer Litotriptör Karşılaştırması: Tek Merkez Deneyimi AU - Canakcı, Cengiz AU - Özkaptan, Orkunt AU - Dinçer, Erdinç AU - Bıçaklıoğlu, Fatih AU - Türkyılmaz, Oğuz AU - Yılmaz, Uğur PY - 2025 DA - May Y2 - 2025 DO - 10.54233/endourolbull-1603757 JF - Endoüroloji Bülteni JO - Endourol Bull PB - Endourology Association WT - DergiPark SN - 2148-0532 SP - 54 EP - 60 VL - 17 IS - 2 LA - en AB - Objective: The aim of this study was to compare the efficacy and safety of lithotripters used in supine mini percutaneous nephrolithotomy.Material and Methods: Medical record of patients who underwent mini percutaneous nephrolithotomy in supine position between January 2023 and June 2024 due to kidney stone larger than 2 cm were evaluated. Thirty-nine patients were operated with Ho:YAG laser lithotripter (LL) and 54 patients were operated with pneumatic lithotripter (PL). Results of patients’ demographics, stone size, stone density, operation time, stone-free rate (SFR), complications were compared.Results: Mean age was 49.56±13.02 in LL group and 50.20±14.24 in PL group (p=0.825). Mean stone size was 3184±2117 mm³ in LL group and 4117±2975 mm³ in PL group and the results were similar between groups (p=0.097). Operation time was significantly higher in LL group than PL group (99.8±24.7 min, 85.7±28.1 min, respectively). SFR at postoperative 3rd month was similar between groups (92% in LL, 87% in PL) (p=0.512). Hemoglobin decrease rate (1.5±1.1 g/dL (IQR 1.5 g/dL) (LL) vs. 1.6±1.0 g/dL (IQR 1.6 g/dL) (PL), p=0.513) and overall complication rates (20% vs. 18%, p=0.897, respectively) were similar in the groups.Conclusion: Both lithotripters can be preferred effectively in supine percutaneous lithotomy. Ballistic lithotripters are still a safe and effective option for mini-PNL with the advantage of reduced operation time. KW - kidney stone KW - lithotripsy KW - Percutaneous nephrolithotomy N2 - Amaç: Bu çalışmanın amacı supin mini perkütan nefrolitotomide kullanılan litotriptörlerin etkinlik ve güvenilirliklerini karşılaştırmaktır.Gereç ve Yöntemler: Ocak 2023 ile Haziran 2024 tarihleri arasında 2 cm’den büyük böbrek taşı nedeniyle supin pozisyonda mini perkütan nefrolitotomi uygulanan hastaların tıbbi kayıtları değerlendirildi. Otuzdokuz hasta Ho:YAG lazer litotriptör (LL) ve 54 hasta pnömatik litotriptör (PL) ile ameliyat edildi. Hastaların demografik özellikleri, taş boyutu, taş yoğunluğu, operasyon süresi, taşsızlık oranı, komplikasyon sonuçları karşılaştırıldı.Bulgular: Ortalama yaş LL grubunda 49,56±13,02 ve PL grubunda 50,20±14,24 idi (p=0,825). Ortalama taş boyutu LL grubunda 3184±2117 mm³ ve PL grubunda 4117±2975 mm³ idi ve sonuçlar gruplar arasında benzerdi (p=0,097). Operasyon süresi LL grubunda PL grubuna göre istatistiksel olarak daha yüksekti (99,8±24,7 dak, 85,7±28,1 dak, sırasıyla). Ameliyat sonrası 3. ayda taşsızlık oranı gruplar arasında benzerdi (LL’de %92, PL’de %87) (p=0,512). Hemoglobin düşüş oranı (1,5±1,1 g/dL (IQR 1,5 g/dL) (LL) vs. 1,6±1,0 g/dL (IQR 1,6 g/dL) (PL), p=0,513) ve genel komplikasyon oranları (sırasıyla %20 vs. %18, p=0,897) gruplarda benzerdi.Sonuç: Her iki litotriptör de supin perkütan litotomide etkili bir şekilde tercih edilebilir. Balistik litotriptörler, operasyon süresini kısaltma avantajıyla mini-PNL için hala güvenli ve etkili bir seçenektir. CR - 1. Turk C, Petrik A, Sarica K et al. EAU guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475- 82. https://doi.org/10.1016/j.eururo.2015.07.041 CR - 2. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol. 2007;51:899-906. https://doi.org/10.1016/j.eururo.2006.10.020 CR - 3. Jiang K, Zhang P, Xu B, et al. Percutaneous Nephrolithotomy vs. Retrograde Intrarenal Surgery for Renal Stones Larger than 2cm in Patients with a Solitary Kidney: A Systematic Review and a Meta-Analysis. Urol J. 2020;17:442- 448. https://doi.org/10.22037/uj.v16i7.5609 CR - 4. Helal M, Black T, Lockhart J, Figueroa TE. The Hickman peel-away sheath: alternative for pediatric percutaneous nephrolithotomy. J Endourol. 1997;11:171-2. https://doi.org/10.1089/end.1997.11.171 CR - 5. Jackman SV, Docimo SG, Cadeddu JA, et al. The “mini-perc”technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol. 1998;16:371-4. https://doi.org/10.1007/s003450050083 CR - 6. Lahme S. Miniaturisation of PCNL. Urolithiasis. 2018;46:99-106. https://doi.org/10.1007/s00240-017-1029-3 CR - 7. Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol. 2008;54:1393-403. https://doi.org/10.1016/j.eururo.2008.07.073 CR - 8. Li P, Ma Y, Liao B, et al. Comparison of safety and efficacy of different positions in percutaneous nephrolithotomy: a network meta-analysis. Int J Surg. 2024;110:2411-2420. https://doi.org/10.1097/JS9.0000000000001130 CR - 9. Keller EX, DE Coninck V, Proietti S, et al. Prone versus supine percutaneous nephrolithotomy: a systematic review and meta-analysis of current literature. Minerva Urol Nephrol. 2021;73:50-58. https://doi.org/10.23736/S2724- 6051.20.03960-0 CR - 10. Ibis MA, Özsoy AF, Özkaya MF, et al. Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers. BMC Urol. 2024;24:54. https://doi.org/10.1186/s12894-024-01443-6 CR - 11. Sharma A, Giri A, Garg G, et al. A prospective comparative study to evaluate safety and efficacy of pneumatic versus laser lithotripsy in mini-percutaneous nephrolithotomy. Am J Clin Exp Urol. 2023;11:258-264. https://pmc. ncbi.nlm.nih.gov/articles/PMC10333137 CR - 12. Ganesamoni R, Sabnis RB, Mishra S, et al. Prospective randomized controlled trial comparing laser lithotripsy with pneumatic lithotripsy in miniperc for renal calculi. J Endourol. 2013;27:1444-9. https://doi.org/10.1089/ end.2013.0177 CR - 13. Aminsharifi A, Irani D, Amirzargar H. Shock Wave Lithotripsy is More Effective for Residual Fragments after Percutaneous Nephrolithotomy than for Primary Stones of the Same Size: A Matched Pair Cohort Study. Curr Urol. 2018;12:27-32. https://doi.org/10.1159/000447227 CR - 14. Papatsoris AG, Zaman F, Panah A, Masood J, El-Husseiny T, Buchholz N. Simultaneous anterograde and retrograde endourologic access: “the Barts technique”. J Endourol. 2008 Dec;22(12):2665-6. https://doi.org/10.1089/ end.2008.0283 CR - 15. Yin X, Tang Z, Yu B, et al. Holmium: YAG laser lithotripsy versus pneumatic lithotripsy for treatment of distal ureteral calculi: A meta-analysis. J Endourol 2013;27:408–414. https://doi.org/10.1089/end.2012.0324 CR - 16. Mager R, Balzereit C, Gust K, et al. The hydrodynamic basis of the vacuum cleaner effect in continuous-flow PCNL instruments: an empiric approach and mathematical model. World J Urol. 2016;34:717–24. https://doi. org/10.1007/s00345-015-1682-5 CR - 17. Cheng F, Yu W, Zhang X, et al. Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol. 2010;24:1579–1582. https://doi.org/10.1089/end.2009.0581 CR - 18. Timm B, Farag M, Davis NF, et al. Stone clearance times with mini-percutaneous nephrolithotomy: Comparison of a 1.5 mm ballistic/ultrasonic mini-probe vs. laser. Can Urol Assoc J. 2021;15:E17-E21. https://doi.org/10.5489/ cuaj.6513 CR - 19. Liu C, Zhou H, Jia W, Hu H, Zhang H, Li L. The Efficacy of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy vs. the Holmium Laser: a Randomized Study. Indian J Surg. 2017;79:294-298. https://doi.org/10.1007/ s12262-016-1473-2 CR - 20. Tangal S, Sancı A, Baklacı U, et al. What is the optimum lithotripsy method for high density stones during miniPNL? Laser, ballistic or combination of both. Lasers Med Sci. 2020;35:1765-1768. https://doi.org/10.1007/s10103- 020-02971-x CR - 21. Cheng F, Yu W, Zhang X, Yang S, Xia Y, Ruan Y. Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol. 2010;24:1579-82. https://doi.org/10.1089/end.2009.0581 UR - https://doi.org/10.54233/endourolbull-1603757 L1 - https://dergipark.org.tr/en/download/article-file/4450811 ER -