Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Percutaneous nephrolithotomy (PNL) is a standard treatment for large or complex kidney stones.
• Bilateral renal stones often require staged procedures, increasing treatment duration and healthcare burden.
• Evaluating single-session bilateral approaches is crucial for optimizing patient management and resource utilization.

Purpose of the Study:

• To compare the safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) versus staged-Mini-PNL for adult patients with bilateral renal stones.
• To assess key outcomes including stone-free rates, operative time, hospital stay, and complication profiles.

Main Methods:

• A prospective comparative study involving 45 patients (90 renal units) undergoing BSS-Mini-PNL and 55 patients (110 renal units) undergoing staged-Mini-PNL between July 2014 and December 2017.
• Mini-PNL was performed using an 18-Fr tract in the prone position under regional anesthesia with pneumatic lithotripsy and a semirigid ureteroscope.
• Statistical analysis included Mann-Whitney, Student t, chi-square, and Fisher's exact tests to compare groups.

Main Results:

• Groups were comparable in stone burden (3.36 ± 1.61 vs 3.38 ± 1.18 cm²) and staghorn stone prevalence (13.3% vs 8.2%).
• No significant differences were observed in the number of tracts, tubeless Mini-PNL rates (81.1% vs 85.5%), or stone-free rates (90% vs 92.7%).
• BSS-Mini-PNL demonstrated significantly shorter operative time (126.22 ± 37.2 vs 169.63 ± 61.28 minutes) and hospital stay (2 vs 4 days), with comparable complication rates (17.8% vs 13.6%).

Conclusions:

• Bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) is a safe and effective alternative to staged procedures for selected patients with bilateral renal stones.
• BSS-Mini-PNL offers significant advantages in reducing cumulative operative time and hospital stay.
• The shorter treatment duration and reduced hospital stay associated with BSS-Mini-PNL may lead to decreased overall healthcare costs.