Kidney stabilization in supine percutaneous nephrolithotomy: impact on surgical efficiency and stone-free rates

Kidney mobility during supine percutaneous nephrolithotomy (sPCNL) may negatively affect the accuracy of the approach and surgical efficacy. This study investigated the effects of kidney stabilization on surgical efficacy, stone-free rate (SFR), and complication profile. Eighty-five patients who underwent standard sPCNL for ≥ 2 cm kidney stones between January and August 2025 were retrospectively reviewed. Patients were divided into two groups: conventional sPCNL (Group C, n = 41) and sPCNL with external gel bag for kidney stabilization (Group F, n = 44). Demographic and stone characteristics, operative time, access time, fluoroscopy time, hemoglobin drop, transfusion rates, length of stay (LOS), complications, and SFR were compared. The groups were similar in terms of demographic and stone characteristics. In Group F, the operative time (74.7 ± 32.2 vs. 97.5 ± 38.0 min, p = 0.004), access time, and fluoroscopy time were significantly shorter (p < 0.001 for both). LOS was shorter in Group F (2.3 vs. 3.1 days, p = 0.001). Hemoglobin decline was less in Group F (1.20 ± 0.81 vs. 1.78 ± 1.31 g/dL, p = 0.017). Transfusion and major complication rates were similar. SFR was significantly higher in Group F (88.6% vs. 70.7%, p = 0.030). Multivariate analysis demonstrated that kidney stabilization was an independent predictor of achieving stone-free status (p = 0.032). Kidney stabilization reduces mobility during sPCNL, thereby shortening operative and fluoroscopy times, reducing blood loss, and improving SFR. These retrospective findings suggest that this simple technique may enhance surgical efficiency; however, its clinical value should be confirmed in prospective studies.