Editorial Comment for Bhattu et al.

The authors are to be congratulated on their impressive results using the mini-perc approach for percutaneous stone removal. Using kidneys-ureters-bladder radiography and renal ultrasonography, complete stone clearance was achieved in almost 99% of patients. The majority of patients were managed tubeless, although all of these patients had either a Double-J stent or a ureteral catheter for a brief period. No complications occurred in 95% of patients, and Clavien level II complications occurred in only 1 patient.

These are impressive outcomes. Some perspective is in order, however. The vast majority of patients treated in this series had stones <2 cm in diameter with a mean stone size overall in this series of about 15 mm. Patients with stone burden in this range are generally treated with shockwave lithotripsy or flexible ureteroscopy, both procedures necessitating a lower level of technical expertise than with the mini-perc procedure.

The real question here is: What is the actual role for mini-perc in patients with less complex stone problems and should we be adding the equipment to our percutaneous armamentarium? I can certainly see the advantages of mini-perc in the pediatric age group where a percutaneous procedure is indicated. The relative balance between mini-perc and less invasive approaches, however, will need further study in well-designed comparative trials.