Comparative Outcomes of Mini-Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy for Renal Stones:...

Background Renal stone disease constitutes a significant global urological burden, with percutaneous nephrolithotomy (PCNL) serving as the gold-standard treatment for large calculi. Mini-PCNL has emerged to reduce morbidity while preserving efficacy; however, comparative prospective evidence from South Asian settings, including Bangladesh, remains scarce. This study aimed to compare the clinical outcomes, including efficacy and morbidity, of mini-PCNL and standard PCNL in the management of renal stones. Methods A prospective comparative study was conducted at the Department of Urology, Chittagong Medical College Hospital, Chattogram, Bangladesh, and two private hospitals in the same region from May 2019 to April 2020. A total of 100 adult patients with renal calculi (1-3 cm) were recruited through nonprobability consecutive sampling and allocated equally into two groups on the basis of surgeon discretion and intraoperative judgment: standard PCNL (24-28 Fr, n = 50) and mini-PCNL (14-20 Fr, n = 50). Operative parameters, postoperative pain (visual analog scale (VAS) score), hemoglobin drop, hospital stay, stone-free rate, renal function, and complications were compared between the groups. Data were analyzed using independent t-tests and chi-square tests, with p < 0.05 considered statistically significant. Results Baseline characteristics, including age, sex, and stone size, were comparable between the groups. Mini-PCNL demonstrated a significantly shorter access time (4.28 ± 0.57 vs 7.87 ± 0.39 min, p < 0.001) and fluoroscopy time (3.75 ± 0.51 vs 5.83 ± 0.65 min, p < 0.001) but a longer operative time (94.53 ± 13.56 vs 78.60 ± 17.80 min, p < 0.001). Postoperative pain (VAS score: 5.52 ± 1.24 vs 7.04 ± 1.09, p < 0.001), hemoglobin drop (1.02 ± 0.32 vs 1.31 ± 0.79 g/dL, p = 0.018), and length of hospital stay (2.32 ± 0.46 vs 3.13 ± 0.72 days, p < 0.001) were significantly lower in the mini-PCNL group. Stone-free rates, renal function outcomes, and complication rates were comparable between the two techniques. Conclusions In this study, mini-PCNL was associated with lower perioperative morbidity, shorter hospital stay, and reduced fluoroscopy exposure compared with standard PCNL, while stone clearance was comparable between the two groups. However, operative time was longer with mini-PCNL. Given the nonrandomized allocation and potential for selection bias, these findings should be interpreted with caution. Larger randomized multicenter studies are needed to confirm these observations.