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Standard-PCNL vs Mini-PCNL vs Super-mini PCNL for the Treatment of ≥2 cm Renal Stone

NCT ID: NCT03771365

Last Updated: 2018-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

3000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-01-01

Study Completion Date

2022-01-01

Brief Summary

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Background: Standard-PCNL was considered as the first choice for ≥2 cm renal stones. Miniaturized technique Mini-PCNL has also been implicated in the past two decades. Recently, Super-mini PCNL (SMP) was introduced to treated ≤2.5cm renal stone. The miniaturized techniques seemed to take a longer operating time and have risk of getting infectious complications. However, there is no high quality of evidence showing that which kind of PCNL is best or what kind of patients is suitable for standard-PCNL, mini-PCNL or SMP.

Objective: To compare the efficacy and safety of Standard-PCNL (≥24Fr), Mini-PCNL (12-20Fr) and SMP(10-14Fr) for the treatment of ≥2 cm renal stones Study design: This study is a prospective, observational, international, multicenter registry cohort study Study population: All patients ≥14 years with ≥2 cm renal stone who are planned for Standard-PCNL, Mini-PCNL or SMP are eligible for this study.

Detailed Description

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BACKGROUND AND RATIONALE Percutaneous nephrolithotomy (PCNL) is the first-choice for the treatment of renal stone ≥20 mm with high stone free rate (SFR). However, there are some sever complications such as bleeding. Severe bleeding needs arterial embolization, which might impair the renal function. The size of percutaneous access tract has been proven to be closely related to the risk of bleeding complications. Mini-PCNL was firstly introduced by Jackman in 1998 to treat pediatric renal stone with the aim to lower the morbidity. Mini-PCNL was gradually applied to adults. In recent years, urologists were still attempting to reduce size of the sheath and modify the sheath. They aimed to reduce the risk of bleeding. The first generation SMP consists of a 10-14 F access sheath with a suction-evacuation function and a 7-F nephroscope with enhanced irrigation was introduced by Guohua Zeng's group in 2014. In 2016, Guohua Zeng's group continued to introduce a modified SMP technique and system. The most remarkable feature of the new generation super-mini percutaneous nephrolithotomy (New-SMP) was metal irrigation-suction sheath which made the new system have higher efficiency than the old one. With the modified SMP technique and system, SMP was performed to treat large renal stone. (≥2cm). Moreover, SMP with an irrigation-suction sheath obviously improved the efficiency of removing the fragments and lower the intrapelvic pressure.

Although miniaturized techniques decreased the bleeding-related morbidity and have a similar SFR, they seemed to take a longer operating time and have risk of getting infectious complications. However, till now, no high quality of evidence demonstrated that what size of tract is the best for the treatment of ≥2 cm renal stone. Perhaps the investigators should find out a subgroup suitable for standard-PCNL, Mini-PCNL or SMP respectively.

STUDY OBJECTIVES The aim of this registry is to review current clinical practice on PCNL for stone treatment. The investigators will explore the answers to the following questions: What kind of PCNL urologists prefers to used? Is there a best cutoff based on the size of stones to divide the patients into subgroups, or a scoring system to decide which kind of PCNL is the best choice for individuals? Primary Objective To compare the stone free rate (SFR) (%) among standard-PCNL, Mini-PCNL and SMP for the treatment of ≥2 cm renal stone.

Secondary Objectives

1. Bleeding complication: hematocrit drop (g/L) and rate of transfusion (%).
2. Infectious complication: rate of getting fever (≥38℃) (%) and urosepsis (%).
3. Intraoperative indexes: operating time (mins), rate of tubeless/total tubeless (%).
4. Postoperative indexes: hospital stay (mins), visual analogue scale (VAS) score (range from 0-10, the higher value represents the worse outcome) STUDY DESIGN This study is a prospective, observational, international, multicenter registry cohort study SELECTION AND ENROLLMENT OF PARTICIPANTS Clinical Recruitment All sites for this pilot study are recruited by IAU Members. Each participating center should obtain ethical approval, as needed, according to local regulations.

Each participating centre will include all consecutive eligible patients. PCNL procedures are performed according local protocols and surgeons' own propensity. Data will be collected in the IAU online platform (http://47.74.212.47/#/login), which is developed by IAU. Each participating center has own account and password to login and collect data. Data analysis will be coordinated by IAU.

Study Population All patients ≥14 years with ≥2 cm renal stone who are planned for Standard-PCNL, Mini-PCNL or SMP are eligible for this study.

Surgical procedure The procedure of SMP, mini-PCNL and Standard-PCNL was according to surgeons' propensity, the related details were recorded online.

Conditions

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Stone, Kidney Lithiasis Renal Surgery

Keywords

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percutaneous nephrostolithotomy renal stone safety efficacy

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Standard-PCNL

Perform PCNL with ≥24 Fr access tract for the treatment of ≥2 renal stones

Standard-PCNL

Intervention Type PROCEDURE

percutaneous nephrostolithotomy (PCNL) with ≥24 Fr access tract for the treatment of ≥2 cm renal stone

Mini-PCNL

Perform PCNL with 12-20 Fr access tract for the treatment of ≥2 renal stones

Mini-PCNL

Intervention Type PROCEDURE

percutaneous nephrostolithotomy (PCNL) with 12-20 Fr access tract for the treatment of ≥2 cm renal stone

Super-mini PCNL

Perform SMP for the treatment of ≥2 renal stones

SMP

Intervention Type PROCEDURE

percutaneous nephrostolithotomy (PCNL) with 10-14 Fr access tract for the treatment of ≥2 cm renal stone

Interventions

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Standard-PCNL

percutaneous nephrostolithotomy (PCNL) with ≥24 Fr access tract for the treatment of ≥2 cm renal stone

Intervention Type PROCEDURE

Mini-PCNL

percutaneous nephrostolithotomy (PCNL) with 12-20 Fr access tract for the treatment of ≥2 cm renal stone

Intervention Type PROCEDURE

SMP

percutaneous nephrostolithotomy (PCNL) with 10-14 Fr access tract for the treatment of ≥2 cm renal stone

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient ≥14 years old
* Patient is a candidate for Standard-PCNL, Mini-PCNL or SMP treatment of a renal stone

Exclusion Criteria

* Patient \<14 years old
Minimum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Military Medical Academy, Bulgaria

OTHER

Sponsor Role collaborator

Massachusetts General Hospital

OTHER

Sponsor Role collaborator

Hospital de Clinicas José de San Martín

OTHER

Sponsor Role collaborator

Goldstadt Private Clinic

UNKNOWN

Sponsor Role collaborator

University College London Hospitals

OTHER

Sponsor Role collaborator

Hospital de Base do Distrito Federal

UNKNOWN

Sponsor Role collaborator

Mexican National Council of Urology

UNKNOWN

Sponsor Role collaborator

Vancouver General Hospital

OTHER

Sponsor Role collaborator

Lions Kidney Hospital and Urology Institute

UNKNOWN

Sponsor Role collaborator

Mt. Carmel Diocesan General Hospital

UNKNOWN

Sponsor Role collaborator

Clinical Emergency County Hospital

UNKNOWN

Sponsor Role collaborator

University of Belgrade

OTHER

Sponsor Role collaborator

Hospital das Clínicas, University of Sao Paulo Medical School

UNKNOWN

Sponsor Role collaborator

Vayodha and Venus International Hospitals

UNKNOWN

Sponsor Role collaborator

University Hospital of Vinalopo

UNKNOWN

Sponsor Role collaborator

Sismanoglio General Hospital

OTHER

Sponsor Role collaborator

New Mowasat Hospital

UNKNOWN

Sponsor Role collaborator

The First Affiliated Hospital of Guangzhou Medical University

OTHER

Sponsor Role lead

Responsible Party

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Guohua Zeng

Vice president

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guohua Zeng, PH.D & MD

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Guangzhou Medical University

Central Contacts

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Guohua Zeng, PH.D & MD

Role: CONTACT

Phone: +86 13802916676

Email: [email protected]

Chao Cai, PH.D & MD

Role: CONTACT

Phone: +86 13512780911

Email: [email protected]

Other Identifiers

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1stAHGZMU

Identifier Type: -

Identifier Source: org_study_id