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Clinical Outcomes Comparing Mini Versus Standard PCNL Without Postoperative Nephrostomy Tube: A Multi-institutional
Tyler Sheetz1, Jamie L Finegan1, Sri Sivalingam2
1Department of Urology, UC San Diego Health, San Diego, CA.
Urology
|November 15, 2025
Summary
Miniature tract percutaneous nephrolithotomy (PCNL) without postoperative tubes shows no significant difference in stone-free rates or complications compared to standard PCNL. Surgeons can choose tract size based on patient needs and practice.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithotomy
Background:
- Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
- The optimal tract size for PCNL remains a subject of investigation.
- Minimizing complications while maintaining efficacy is a primary goal in PCNL.
Purpose of the Study:
- To compare outcomes of miniature tract (17.5Fr) versus standard tract (30Fr) PCNL.
- To assess complications, stone-free rates, and operative time in PCNL without postoperative nephrostomy tubes.
- To determine if a smaller PCNL tract size offers advantages.
Main Methods:
- A multi-institutional randomized controlled trial was conducted.
- Patients were randomized to either a 17.5Fr miniature tract or a 30Fr standard tract for PCNL.
- No postoperative nephrostomy tubes were used in either group.
Main Results:
- No statistically significant differences were observed in hemoglobin decrease, blood transfusion rates, stone-free rates (77% mini vs. 71% standard), or operative time.
- Clavien-Dindo complication rates (15% mini vs. 14% standard) and systemic inflammatory response syndrome (SIRS) criteria were similar between groups.
- Pain scores in the post-anesthesia care unit were low and not significantly different.
Conclusions:
- Miniature tract PCNL without postoperative nephrostomy tubes yields comparable intraoperative, postoperative, and stone-free outcomes to standard tract PCNL.
- The choice of PCNL tract size can be individualized based on patient, institutional, and practice requirements.
- This study supports the flexibility in selecting PCNL tract size without compromising patient outcomes.