The initial clinical application of standard PCNL combined with visual needle nephroscope in the treatment of complex renal calculi

Abstract Purpose: To present the feasibility, safety and effectiveness of an optimized treatment of complex renal calculi based on visual needle nephroscopy. Methods: We collected data of 31 patients with complex kidney calculi, who underwent standard PCNL combined with visual needle nephroscope (“needle-perc”, Youcare@, Wuhan, China). The percutaneous nephroscopic working channel was established by visual needle nephroscope, and the primary channel was expanded to 20F to treat most of the main body of the calculi with a 550 μm holmium laser fiber. Visual needle nephroscope was used to locate the renal calyx where the residual calculi were located for precise puncture as a secondary channel, and the residual stones were treated by a 200 μm holmium laser fiber. Clinical data were collected, and intraoperative variables, postoperative complications and outcomes were assessed. Results: All 31 patients successfully completed the operation without severe complications. The S.T.O.N.E. score of 31 patients before operation was 10.5±0.9 points and above, of which the N score was more than 2 points. The average operation time was (65.5±12.7) minutes, and the average hospital stay was (7.3±2.1) days. After operation, 1 patient developed a fever, which improved after symptomatic treatment by intravenous antibiotics. 2 patients had clinically significant residual fragments, and the stone-free rate of primary operation was 93.5% (29/31). Conclusions: The optimized operation for the treatment of complex renal calculi based on standard PCNL combined with visual needle nephroscope has good feasibility, safety and effectiveness.