Prospective randomized study of various techniques of percutaneous nephrolithotomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Percutaneous nephrolithotomy (PCN) is a key procedure for kidney stone removal.
• Modifications like mini-PCN and tubeless PCN aim to reduce patient morbidity and improve outcomes.
• Comparative data on these techniques are crucial for clinical decision-making.

Purpose of the Study:

• To compare the morbidity and complications associated with standard PCN, mini-PCN, and tubeless PCN.
• To determine the efficacy and safety profiles of these modified PCN techniques.

Main Methods:

• A prospective randomized trial involving 30 patients (10 per group) was conducted.
• Techniques compared: Standard PCN (30F/34F sheath), mini-PCN (22F/26F sheath), and tubeless PCN (using double-J stent).
• Outcomes assessed included postoperative pain, operative time, blood loss, hospitalization length, cost, and complications.

Main Results:

• Tubeless PCN demonstrated reduced morphine use, shorter hospitalization, and lower procedural costs.
• Complications (renal bleeding requiring transfusion) occurred in both standard and mini-PCN groups.
• Mini-PCN offered no clear advantage over standard PCN and had poorer visualization.

Conclusions:

• Tubeless PCN is associated with the least morbidity and highest cost efficiency.
• Mini-PCN does not offer significant benefits over standard PCN and presents disadvantages in visualization and instrument handling.
• Tubeless PCN emerges as a favorable modification for kidney stone treatment.