Is Nonpapillary Puncture a Feasible Alternative to Papillary Access in Percutaneous Nephrolithotomy? A Systematic...

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is a primary treatment for large renal calculi.
• Puncture path selection (papillary vs. nonpapillary) is debated due to bleeding risks.

Purpose of the Study:

• To systematically review and compare the safety and efficacy of nonpapillary versus papillary access in PCNL.
• To evaluate bleeding risk, complication rates, and stone-free rates (SFR) between the two access methods.

Main Methods:

• A comprehensive literature search was conducted across multiple databases up to December 2025.
• Included comparative trials reporting postoperative hemoglobin drop, complication rate, SFR, or operative time.
• Quality assessment used Cochrane Risk of Bias Tool 2.0 and Newcastle-Ottawa Scale; analysis in Stata 17.0.

Main Results:

• Nine studies with 1229 patients (787 papillary, 442 nonpapillary) were analyzed.
• No significant differences in hemoglobin drop, overall complications, transfusion rates, or SFR between groups.
• Prospective studies showed nonpapillary access had significantly shorter operative times.

Conclusions:

• Nonpapillary access is a safe and effective PCNL alternative with comparable outcomes to papillary access.
• Potential efficiency gains with nonpapillary access, especially in standardized settings.
• Flexible puncture path selection is recommended; Doppler ultrasound can aid in avoiding vascular areas.