Does suction in Mini PCNL mitigate rise in intrarenal pressure? A prospective randomised study

The rise in intra-renal pressure during Mini PCNL (percutaneous nephrolithotripsy) potentially leads to pyelovenous backflow and infectious complications. This prospective randomized study compares intra-renal pressure (IRP) in patients undergoing Mini PCNL (mPCNL) procedure with and without suction for renal stones. Suction mPCNL is expected to lower IRP by continuously aspirating irrigation fluid and stone fragments, thereby enhancing procedural safety. A total of 100 patients with kidney stones measuring 1-4 cm were randomized into two groups: Mini PCNL with suction (n = 50) and Mini PCNL without suction (n = 50). IRP was measured using a pressure transducer connected to a ureteral catheter. Key outcome measures included intra-renal pressure, stone-free rate, operative time, and complication rates. The suction mPCNL group demonstrated a significantly lower IRP (16.92 ± 2.93 mmHg) compared to the non-suction group (19.48 ± 4.77 mmHg, p = 0.002). The suction group also experienced shorter mean operative times (35.98 ± 14.10 min vs. 47.12 ± 15.36 min, p = 0.001) and lithotripsy times (19.50 ± 11.70 min vs. 26.24 ± 10.49 min, p = 0.003). The stone-free rate was higher in the suction group though this difference was not statistically significant. Likewise, the complication rates, including postoperative infection rates (fever and urosepsis) showed a downward trend in the suction group, however the difference was not statistically significant (p > 0.05). Suction mPCNL effectively reduces IRP, shortens operative time, maintains a comparable stone-free rate, making it a safer and more efficient alternative to traditional mPCNL. This study highlights the potential advantages of integrating suction mechanisms to control IRP and improve patient outcomes in PCNL procedures.