Fast and effective percutaneous lithotripsy using „Bernoulli effect“

Overview

Hradec T, Vobořil V, Kaplán O, Vávřová L, Zámečník L, Hanuš T. Fast and effective percutaneous lithotripsy using „Bernoulli effect“.

The choice of treatment method for medium size urolithiasis (10–20 mm) is not always easy. Extracorporal shockwave lithotripsy might create multiple large residual fragments, which might cause obstruction of the upper urinary tract. Flexible ureterorenoscopy might be a long, complicated procedure with the risk of infectious complications. Percutaneous lithotripsy (PCNL) is very effective, but the use of standard size PCNL instruments (24–30 CH) might be too invasive and require prolonged hospitalisation.

Mini-PCNL (16 CH) with the use of „Bernoulli” or „vacuum cleaner” effect for irrigation of fragments from the upper tract seems to be an excellent choice of treatment. It is fast, effective and it does not require use of any expensive extraction devices. We would like to present our experience with mini-PCNL using Karl Storz MIP instruments. The advantage of this method is small diameter access, minimal blood loss and single step dilatation, without traumatisation of the upper urinary tract. The fragmentation is easily performed by standard Ho:YAG laser.

We have used this technique in seven patients with the average stone size of 12 mm. Total procedure time, including insertion of ureterical catheter and rotation of the patient into the prone position was 68 minutes on average. We identified residual fragments smaller then 2 mm on a CT scan early after procedure in one patient. All the other patients were stone free right after the surgery. The procedure did not lead to significant blood loss, which would require blood transfusion in any of the patients.

Mini-PCNL with a 16 CH access tract and the use of „Bernoulli effect” for fragment evacuation, is a safe and very effective treatment method for medium size stones.

Keywords:

Percutaneous lithotripsis – mini-PCNL – vacuum cleaner effect – Bernoulli effect – medium size stone treatment