Mini-PCNL for Lahme kidney stones
Lahme Mini-PCNL is a minimally invasive surgical procedure for larger kidney stones in which a thin tube is inserted into the kidney after making an ultrasound-guided puncture through the skin. The kidney stone can then be crushed with the laser and then the fragments flushed out through the tube. Mini PCNL as a procedure for adults was developed by Prof. Sven Lahme, MD, and published in 2011. Since then, this surgical procedure has established itself worldwide as the procedure of choice for large kidney stones. Prof. Lahme has demonstrated these procedures in many countries during guest surgeries. In 2016, he received a visiting professorship in Guangzhou, China, for his scientific work on this topic. You can find out more about the Mini-PCNL in the video here.
|Indication||Kidney stones > 2cm|
|Procedure||Disintegration of the kidney stone with a laser. Removal of the kidney stones through the skin.|
|Surgery time||Approx. 1 hour|
|Clinic stay||3-4 days|
|Note||General anaesthesia recommended|
Questions about the Mini-PCNL
Mini-PCNL is an abbreviation for minimally invasive percutaneous nephrolithopaxy. It is a procedure to remove larger kidney stones, in which all fragments are removed from the kidney via a tube after the stone has been crushed with a laser. Mini-PCNL is performed with a miniaturised instruments that has only about 20% of the cross-sectional area of a conventional nephroscope. This makes the Mini-PCNL much gentler and less likely to cause complications.
The guidelines of national and international urological societies recommend PCNL for stones with a diameter of 2 cm or more. Depending on the location of the stone and other circumstances, a Mini-PCNL can also be performed on kidney stones as small as 1 cm.
Yes, the Mini-PCNL can be performed on children from 6 months of age up to patients of advanced ages. The method can also be performed on most positional anomalies of the kidneys, such as horseshoe kidneys. The Mini-PCNL is not advisable only for patients with blood coagulation disorders.
The Mini-PCNL is performed with a miniaturised nephroscope that has a diameter of <4mm. The standard nephroscope has a diameter of approx. 8.5mm. The cross-sectional area of standard nephroscopes is therefore about five times larger. Miniaturisation makes access to the kidney less dangerous and lowers the risks of complications, such as bleeding. In a Mini-PCNL, the stones are crushed by the laser so that they only need to be rinsed out. With standard PCNL, the stone fragments typically have to be pulled out with grasping forceps.
Using ultrasound control, the hollow system of the kidney is punctured with a thin needle. Using radiological control, a guide wire is inserted and the puncture channel is widened so that a tube can be inserted. The mini-nephroscope is pushed into the hollow system of the kidney through this tube, and the urinary stone treatment can then be carried out.
With the Mini-PCNL, a stone-free rate of approx. 95% can be achieved. As a rule, only one surgical session is required. In case of larger kidney stones that affect several renal calices, a second puncture may be necessary in the same session. As a result, Mini-PCNL is one of the kidney stone treatment methods with the highest success rate.
The most common risk of a Mini-PCNL is febrile inflammation, which requires antibiotic treatment and occurs in about 7% of patients. Temporary bloody urine may occur. Serious bleeding as a risk is very rare when the procedure is done by an experienced surgeon.
Unlike other methods of urinary stone treatment, the Mini-PCNL requires an experienced specialist. Since the kidney is one of the organs with the most blood supply in the body, the procedure must be well thought out in advance. High-resolution ultrasound and a modern, digital X-Ray machine with optimal image quality and low radiation exposure are important for a low surgical risk.
The Mini-PCNL is performed on the day that the patient is admitted. A nephrostomy tube (kidney catheter) and a urinary catheter are inserted for urinary diversion after the operation. The urinary catheter is removed on the first day after the operation and the nephrostomy tube is removed on the second day. On the third day after the operation, the patient is usually discharged from inpatient treatment. Pain after a Mini-PCNL procedure is not expected. However, if necessary, the patient may receive pain medication. An outpatient check-up is recommended about 1-2 weeks after being discharged from inpatient treatment.