Background
bleeding, lower pole stones, blood loss, stone complications, kidney stones, kidney of stones
BLOOD LOSS, BLEEDING, KIDNEY STONE, COMPLICATIONS
Since the introduction of percutaneous nephrolithotripsy (PCNL) in 1980 the, the procedure gained popularity and steady development in nephroscope, energy source for stone fragmentation, patient position, puncture site, tract dilatation, smaller nephrostomy tube or tubeless PCNL. The Second wave of development was the miniaturization of instruments that shifted the access sheath of 30 French (Fr) in standard-PCNL, to 14–20 Fr in mini-PCNL [Mini-PCNL in adults showed good stone free rates (SFR), minimal risk of bleeding, decreased hospital stay and reduced the need for postoperative analgesia [Hu G et al reported in a series of 1368 patients undergoing mini-PCNL using 16 Fr tract and stone disintegration within holmium laser or pneumatic lithoclast, the SFR was 82% [Comparing bleeding complications in mini-PCNL and Standard-PCNL, it was lower in mini-PCNL (1.4%) [Mini-PCNL and retrograde intrarenal surgery (RIRS) became the priority in the treatment of kidney stones, both are safe and effective methods particularly for treating lower pole stones with a diameter of 1.5–2.5 cm [Standard-PCNL is considered in recent years an old procedure and would be replaced by mini-PCNL and RIRS, but it has its role in the treatment of large and complex kidney [Considering SFR, it was significantly higher in standard-PCNL compared to mini-PCNL in adult patients with stones less than 2cm [PCNL has a minimal impact on global kidney function in the location of the procedure. Kidneys with some degree of impaired function would benefit from PCNL to alleviate obstruction and protected against stone complications [Zeng et al made a comparison of mini-PCNL and Standard-PCNL for kidney of stones > 2cm, they analyzed the data regarding SFR, intra operative complications, operation time, postoperative outcome, and hospital stay, they concluded that mini-PCNL is an effective treatment of > 2cm kidney stones and is equal to standard-PCNL, both have a comparable SFR, with relative advantage of mini-PCNL of less blood loss and shorter hospitalization [