A Novel Semi-rigid Nephroscope Percutaneous Nephrolithotomy: The Best Therapy for Renal Staghorn Calculi

Percutaneous nephrolithotomy (PCNL) has been the first-line treatment for renal staghorn calculi for many years. Several techniques have been described for percutaneous access and stone removal, but a multi-access approach is the mainstay of treatment. The main concern about PCNL is the resultant morbidity: Complications such as bleeding, parenchymal damage, and organ injury hindered the adoption of PCNL in primary hospitals in China. Multiple access points significantly increase the risk of bleeding, as well as the risks of other major complications. Although single access and flexible nephroscopy has been recommended as the most effective means of curing full staghorn stones, it is less popular as it is labor-intensive and time-consuming. In our opinion, the optimal strategy should be highly efficient and carry low risk, which requires new instruments. We have developed a semi-rigid nephroscope that integrates the function of rigid and flexible nephroscopes, and is manufactured in China by YouCare Technology Co., Ltd. It can be deployed with an ultrasonic or pneumatic lithotripsy system in rigid mode and a holmium laser in flexible mode, switching between the two is straightforward. We hope this nephroscope can achieve the goal of treating complete staghorn calculi efficiently and relatively noninvasively through a single access port. Herein, we report our experience of semi-rigid nephroscopic PCNL in the 1 st year of its use. Informed consents were signed by patients and the study was approved by ethics committee of our hospital. Between August 2013 and August 2014, 60 patients with staghorn calculi were treated in our institution. Thirty were randomized to be treated using the semi-rigid nephroscope and the remaining patients were treated according to a standard technique with a rigid scope. The main body of the semi-rigid nephroscope device comprises four parts: An outer tube, an inner tube, a steering handle, and a tube connector [Figure 1]. The scope can be switched easily between rigid and flexible modes using the steering handle. Ultrasonography was used to locate the stones and identify the correct target calyx in both groups. A 24-Fr tract was created under ultrasound guidance. Briefly, a 17.5-G coaxial needle was introduced into the fornix of the target calyx under ultrasound guidance (3.5-MHz LOGIQ e, GE Healthcare, USA). The correct position was confirmed by aspiration of urine. A tract was dilated serially over the guide wire using 8–16 Fr fascia dilators (UroVision, Bad Aibling, Germany). A 16-Fr peel-away sheath was placed to facilitate …