Single-access mini-PCNL with flexible cystoscopy vs. multi-access mini-PCNL for complex renal stones in prospective...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithotomy

Background:

• Complex renal stones (CRS) present a significant challenge in urological practice.
• Minimally invasive percutaneous nephrolithotomy (MPCNL) is a standard treatment, but optimizing outcomes for CRS is crucial.
• Single-access MPCNL combined with flexible cystoscopy is an emerging technique.

Purpose of the Study:

• To evaluate the efficacy and safety of single-access MPCNL with flexible cystoscopy versus multi-access MPCNL for treating complex renal stones (CRS).
• To compare stone-free rates (SFRs), operative time, blood loss, hospital stay, and complications between the two techniques.

Main Methods:

• A prospective randomized controlled trial involving 195 patients with CRS.
• Patients were randomized into two groups: single-access MPCNL (n=98) and multi-access MPCNL (n=97).
• Primary outcome was SFR; secondary outcomes included operative time, hemoglobin decrease, hospital stay, and complications.

Main Results:

• Single-access MPCNL demonstrated significantly higher SFRs on postoperative day 2 and at 4 weeks (P<0.05).
• The single-access group experienced less hemoglobin decrease (P<0.001) and shorter hospital stays (P<0.001).
• Complication rates, including low back pain, perirenal hematoma, and renal artery embolization, were significantly lower in the single-access group (P<0.05).

Conclusions:

• Single-access MPCNL combined with flexible cystoscopy is an effective and safe treatment for complex renal stones (CRS).
• This technique achieves high stone-free rates while minimizing renal injury and complications.
• The approach is reproducible and ideal for clinical practice, offering advantages over multi-access MPCNL.