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Vacuum-Assisted Mini-PCNL is Associated with Lower Postoperative SIRS: A Real-World Cohort Study
Surawach Piyawannarat1, Kun Sirisopana1, Nipapan Choonu1
1Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Background:
Postoperative systemic inflammatory response syndrome (SIRS) remains a key complication after mini-percutaneous nephrolithotomy (mini-PCNL) and is often related to elevated intrarenal pressure and bacterial translocation. Vacuum-assisted mini-PCNL (VmPCNL) has been developed to mitigate this risk through active pressure control.
Objective:
To evaluate the association between VmPCNL and postoperative SIRS and to identify the independent predictors of SIRS in a real-world cohort.
Materials And Methods:
A retrospective cohort study was conducted of patients undergoing mini-PCNL at a tertiary referral center between January 2021 and May 2025. Patients were stratified into standard mini-PCNL (SmPCNL) and VmPCNL groups. The primary endpoint was SIRS within 48 hours post-surgery. Secondary outcomes included operative time, stone-free rate (SFR), and length of hospital stay (LOS). Multivariable logistic regression was used to identify independent predictors of SIRS.
Results:
A total of 136 patients were included in the study (SmPCNL, n = 78; VmPCNL, n = 58). The incidence of postoperative SIRS was significantly lower in the VmPCNL group (8.6% vs 21.8%, p = 0.036). VmPCNL was also associated with shorter operative time (median 90 minutes vs 115 minutes, p = 0.038) and reduced LOS (p = 0.012). Stone-free rates were comparable between the groups, indicating no compromise in procedural efficacy. In the multivariable analysis, VmPCNL was independently associated with a lower risk of SIRS (adjusted OR [aOR] 0.44, 95% CI 0.19-0.98, p = 0.041), while a positive preoperative urine culture was an independent risk factor (aOR 2.60, 95% CI 1.01-6.60, p = 0.045).
Conclusion:
In this real-world cohort, VmPCNL was associated with a lower SIRS incidence and improved perioperative efficiency without compromising stone-free outcomes. The mechanism may involve improved intraoperative outflow dynamics through active suction, although direct measurement of intrarenal pressure is needed to confirm this hypothesis.
Insights
Vacuum-assisted mini-percutaneous nephrolithotomy (VmPCNL) significantly reduces postoperative systemic inflammatory response syndrome (SIRS) after kidney stone removal. This technique also improves operative efficiency without affecting stone-free rates.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Nephrolithotomy
Background:
- Postoperative systemic inflammatory response syndrome (SIRS) is a significant complication following mini-percutaneous nephrolithotomy (mini-PCNL).
- Elevated intrarenal pressure and bacterial translocation are implicated as key contributors to SIRS.
- Vacuum-assisted mini-PCNL (VmPCNL) was developed to actively control intrarenal pressure and mitigate SIRS risk.
Purpose of the Study:
- To assess the association between VmPCNL and the incidence of postoperative SIRS.
- To identify independent predictors of SIRS in patients undergoing mini-PCNL.
- To evaluate the perioperative efficiency of VmPCNL compared to standard mini-PCNL.
Main Methods:
- Retrospective cohort study of 136 patients undergoing mini-PCNL (January 2021 - May 2025).
- Patients were divided into standard mini-PCNL (SmPCNL) and VmPCNL groups.
- Primary endpoint: SIRS within 48 hours. Secondary outcomes: operative time, stone-free rate (SFR), length of hospital stay (LOS). Multivariable logistic regression used for predictor identification.
Main Results:
- Lower SIRS incidence in the VmPCNL group (8.6%) compared to SmPCNL (21.8%) (p=0.036).
- VmPCNL associated with shorter operative time (90 vs 115 minutes, p=0.038) and reduced LOS (p=0.012).
- Positive preoperative urine culture independently predicted higher SIRS risk (aOR 2.60).
Conclusions:
- VmPCNL is associated with reduced postoperative SIRS incidence and improved perioperative efficiency.
- The technique does not compromise stone-free outcomes.
- Potential mechanism involves improved intraoperative outflow dynamics; further research on intrarenal pressure is warranted.
