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

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Elevated intra-renal pressure during Mini Percutaneous Nephrolithotripsy (mPCNL) can lead to pyelovenous backflow and infections.
• Controlling intra-renal pressure (IRP) is crucial for improving safety and outcomes in PCNL procedures.

Purpose of the Study:

• To compare intra-renal pressure (IRP) in patients undergoing mPCNL with and without suction.
• To evaluate the impact of suction-assisted mPCNL on operative time, stone-free rates, and complications.

Main Methods:

• A prospective randomized study involving 100 patients with 1-4 cm kidney stones.
• Patients were divided into two groups: mPCNL with suction (n=50) and mPCNL without suction (n=50).
• Intra-renal pressure was measured using a transducer connected to a ureteral catheter.

Main Results:

• The suction mPCNL group showed significantly lower IRP (16.92 ± 2.93 mmHg) versus the non-suction group (19.48 ± 4.77 mmHg, p=0.002).
• Mean operative time (35.98 ± 14.10 min) and lithotripsy time (19.50 ± 11.70 min) were significantly shorter in the suction group.
• While the suction group trended towards higher stone-free rates and lower complication rates, these differences were not statistically significant.

Conclusions:

• Suction-assisted mPCNL effectively reduces intra-renal pressure and operative time.
• This technique presents a safer and more efficient alternative to traditional mPCNL for kidney stone treatment.
• Integrating suction mechanisms holds potential for improved patient outcomes in PCNL procedures.