# Innovations in kidney stone management: mini-PCNL for staghorn calculi in resource-limited settings

## TL;DR

This study shows that mini-PCNL with a high-power laser is a safe and effective method for treating large kidney stones in areas with limited medical resources.

## Contribution

The study introduces mini-PCNL as a cost-effective and accessible treatment for staghorn calculi in resource-limited settings.

## Key findings

- Mini-PCNL achieved 67.37% stone clearance within three days and 80.91% after one month.
- Postoperative complications were manageable, with bleeding at 13.14% and fever at 9.75%.
- The procedure offers a viable alternative to traditional methods in low-resource environments.

## Abstract

This study evaluates our initial experience with miniaturized percutaneous nephrolithotomy (mini-PCNL) in Vietnamese patients with staghorn calculi, using an 18F metal access sheath. This technique addresses the challenges of complex kidney stone management in resource-limited settings.

A multi-center retrospective review of 236 patients with staghorn calculi who underwent mini-PCNL with high-power Ho laser lithotripsy (Lumenis 100 W) was conducted at four provincial hospitals in northern Vietnam from January 2020 to December 2023.

Among the 236 patients (mean age 54.88 years), 13.56% had prior open surgery, and 3.81% had previous PCNL. Presenting symptoms included flank/back pain (97.88%), acute renal colic (11.44%), and dysuria (5.93%). Right-sided stones were present in 55.93%, left-sided in 32.63%, and bilateral in 11.44%. The mean stone size was 28.05 mm, with 53.81% having stones of 20–30 mm, 38.56% over 30 mm, and 7.63% under 20 mm. Single stones were noted in 69.07%, while 30.93% had multiple stones. The mean stone surface area was 318.17 mm². Hydronephrosis was observed in 53.81% (grade-1: 32.64%; grade-2: 17.37%; grade-3: 3.81%). Postoperative complications included bleeding (13.14%), fever (9.75%), and reoperation or JJ stent placement (1.69%). Stone clearance rates were 67.37% at three days and 80.91% after one month. The mean durations for ureteral catheterization, postoperative hospitalization, and total hospital stay were 3.29, 6.94, and 12.90 days, respectively.

Mini-PCNL with high-power Ho laser lithotripsy demonstrates safety and efficacy in managing staghorn calculi, achieving favorable stone clearance and recovery outcomes. This approach offers a viable, cost-effective solution for enhancing access to advanced urological care in resource-constrained environments.