The perioperative outcomes of papillary versus non-papillary access in percutaneous nephrolithotomy

To compare the perioperative outcomes of papillary versus non-papillary access in percutaneous nephrolithotomy (PCNL), which is the 'gold standard' for managing large renal calculi.

In this prospective, randomised trial, 70 patients with de novo renal stones amenable to PCNL were allocated to undergo either papillary (n = 35) or non-papillary (n = 35) access. Primary outcomes included haemoglobin drop and the need for blood transfusion. Secondary outcomes assessed were: operative time, stone-free rates (SFRs; initial and final), the need for auxiliary procedures, incidence and grading of complication rates.

There were no statistically significant differences between the papillary and non-papillary groups in terms of perioperative haemoglobin drop (P = 0.971) or transfusion rates (P = 0.69). Although the non-papillary group had a shorter mean operative time (83 vs 92 min, P = 0.103) and a marginally higher initial SFR (88.6% vs 82.9%, P = 0.495), these differences were not statistically significant. Final SFRs were similar (94.3% vs 97.1%, P = 0.555). Both groups experienced low and comparable complication rates, including fever, sepsis, and prolonged urinary leakage, with no significant difference between them.

Both papillary and non-papillary access approaches in PCNL show comparable safety and efficacy. While non-papillary access was associated with a slight reduction in operative time and a higher SFR, these findings were not statistically significant.