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This study was designed to evaluate the non-inferiority of ultrasound puncture followed by endoscopically guided tract dilatation compared to the standard fluoroscopy-guided PCNL. Forty patients with non-opaque kidney stones eligible for PCNL were randomly divided into two groups. The standard fluoroscopy-guided PCNL using the Amplatz dilator was performed in the XRAY group. In the SONO group, the Kidney was punctured under an ultrasound guide followed by tract dilatation using a combination of the Amplatz dilator based on the tract length and an endoscopically guided tract dilatation using a bi-prong forceps in cases of short-advancement. The primary outcome was successful access. In 90% of cases in the XRAY and 95% in the SONO group access dilatation process was performed uneventfully at the first attempt (p = 0.5). In 45% of cases in the SONO group, bi-prong forceps were used as salvage for short-advancement. In one case in the X-ray group over-advancement occurred. One month after surgery, the stone-free rate on the CT-scan was 75% for the X-ray group and 85% for the SONO group (p = 0.4). There were no significant differences in operation time, hospitalization duration, transfusion, or complication rates between the two groups. We conclude that ultrasound-guided renal puncture, followed by endoscopically guided tract dilatation can achieve a high success rate similar to X-ray-guided PCNL while avoiding the harmful effects of radiation exposure and the risk of over-advancement.

Purpose Percutaneous nephrolithotomy (PCNL) as an established procedure for treatment of large kidney stones, can trigger life threatening complications. Postoperative hemorrhaging is one of the main complications of PCNL. This study investigates the effectiveness of balloon nephrostomy in reducing hemorrhage in the postoperative phase of PCNL. Methods and materials A total of 102 patients underwent routine PCNL and then they were randomly allocated to intervention and control groups. For the intervention group, a balloon nephrostomy tube was inserted under guidance of fluoroscopy, gentle traction was applied on the nephrostomy and then it was fixed to skin under mild traction. A conventional nephrostomy tube was inserted in the control group without additional traction. Blood loss was estimated by hemoglobin drop in the first 24 h after surgery. Hemoglobin level drop was the primary endpoint of interest. Secondary endpoints were postoperative complications and were compared between treatment groups. Results The mean first 24-hour hemoglobin drop was 0.9 ± 0.2 mg/dL in the intervention group and 2.1 ± 0.2 mg/dL in the control group which was statistically significant (< 0.001). Although blood transfusion was more common in the control group (8% versus 0%), it was not statistically significant. There were no statistically significant differences between intervention and control groups regarding the postoperative complications. Conclusion In conclusion, the results of the present study show the effectiveness of the application of balloon nephrostomy in decreasing PCNL postoperative bleeding without considerable complication. Trial registration no IRCT20160406027253N2.

We aimed to compare the outcomes of mini-percutaneous nephrolithotomy (mPNL) and standard PNL techniques in the treatment of renal stones ≥ 2 cm. The study was designed as a randomized prospective study between January 2016 and April 2017. The patients with a kidney stone ≥ 2 cm were included in the study. Patients who had uncorrectable bleeding diathesis, abnormal renal anatomy, skeletal tract abnormalities, pregnant patients and pediatric patients (< 18 years old) were excluded from the study. The remaining patients were randomly divided into two groups as standard PNL and mPNL. For both group, demographic data, stone characteristics, operative data and postoperative data were recorded prospectively. The study included 160 consecutive patients who had kidney stone ≥ 2 cm. Of these, patients who met the exclusion criteria and patients who had missing data were excluded from the study. Remaining 97 patients were randomly divided into two groups as mPNL (n: 46) and standard PNL (n: 51). The mean age was 46.9 ± 13.7 and 47.4 ± 13.9 years for mPNL group and sPNL group, respectively. According to Clavien–Dindo classification, no statistical difference was detected between the groups in terms of complication rates (p 0.31). However, the rates of hemoglobin drop and transfusion rates were significantly in favour of mPNL (p 0.012 and p 0.018, respectively). Nephrostomy time and hospitalization time was found to be significantly shorter in mPNL group (p 0.017 and p 0.01, respectively). The success rate in the mPCNL group was higher than standard PNL group, however, this difference was statistically insignificant (76.5 vs 71.7%, p 0.59). Both mPNL and standard PNL are safe and effective treatment techniques for the treatment of kidney stones of ≥ 2 cm. Although there was no significant difference in success rates of both techniques; nephrostomy time, hospitalization time, bleeding and transfusion rates were in favour of mPNL.

Percutaneous nephrolithotomy (PCNL) is considered to be the first line of treatment for large renal stones. Though PCNL comes with higher morbidity, its efficacy is unbeaten by other minimally invasive modalities. However, potential complications, such as bleeding, occur. Improved skills and modifications of the procedure may reduce the probability of adverse outcomes. This article discusses the current trends and standards in PCNL technique with special focus on all important steps as positioning, access, instruments, dilation, disintegration, and exit, including outcomes, complication management, and training modalities.

To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with a flexible vacuum-assisted ureteral access sheath (FV–UAS) in patients with large renal stones (LRS). A total of 149 patients with LRS were prospectively randomized into two groups: 75 in the FV–UAS group and 74 in the minimally invasive percutaneous nephrolithotomy (MPCNL) group. The primary outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary endpoints included the total SFRs 1 month postoperatively, lithotripsy time, hemoglobin reduction, length of postoperative hospital stay, quality of life (QoL) score improvement, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. Patient demographics and preoperative clinical characteristics showed no apparent difference between the two groups (all P  > 0.05). Postoperative data revealed a significantly longer lithotripsy time in the FV–UAS group than the MPCNL group (113.1 vs. 82.5 min, P  < 0.001). The mean decrease in hemoglobin was significantly lower in the FV–UAS group than in the MPCNL group (8.2 vs. 17.7 g/L, P  < 0.001). Similarly, the average hospital stay was shorter in the FV–UAS group than the MPCNL group (1.7 vs. 5.1 d, P  < 0.001). Meanwhile, SFRs on the first postoperative day and 1 month postoperatively were statistically similar between the two groups ( P  > 0.05). QoL improvement was significantly higher in the FV–UAS group than in the MPCNL group (33.4 vs. 26.9, P  < 0.001). The difference in ureteral stricture at 3 months postoperatively was not statistically significant ( P  > 0.05). Notably, the overall rate of postoperative complications was markedly lower in the FV–UAS group than in the MPCNL group ( P  < 0.05). Our study showed the safety and feasibility of applying RIRS combined with FV–UAS for LRS treatment, providing advantages such as high SFRs, minimal trauma, fast recovery, and low incidence of postoperative complications. It can be used as a clinical treatment alternative for LRS. The protocol for this study has been accepted by the Chinese Clinical Trial Registry (Ethics approval number: ChiCTR2200056402; Date of registration: 02-05-2022).

To observe the efficacy and safety of single-access minimally invasive percutaneous nephrolithotomy (MPCNL) combined with flexible cystoscopy and multi-access MPCNL in patients with complex renal stones (CRS). A total of 195 patients with CRS were prospectively randomized into two groups. Ninety-eight in the single-access MPCNL group and 97 cases as control in the multi-access MPCNL group. The stone-free rates (SFRs) at different times were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay and operation-related complications. There was no obvious difference between two groups in patients’ demographics and preoperative clinical characteristics (All P  > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in single-access MPCNL group than that in multi-access MPCNL group ( P  < 0.001). Postoperative hospital stay in single-access MPCNL group was more shorten than that in multi-access MPCNL group ( P  < 0.001). Moreover, the SFRs of the postoperative 2nd day and 4th week in single-access MPCNL group were both significantly higher than those in multi-access MPCNL group (Both P  < 0.05). However, in terms of the rates of low back pain, perirenal hematoma and renal artery embolization, multi-access MPCNL group were all significantly higher than single-access MPCNL group (All P  < 0.05). Our study shows that single-access MPCNL and flexible cystoscopy are ideal complementary techniques in the treatment of CRS, satisfying both high SFR and minimized renal injury. This method was safe and reproducible in clinical practice.

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.

We aimed to determine the postoperative gastrointestinal tract dysfunction and intraoperative hemodynamic effects of ultrasound-guided retrolaminar block in patients undergoing percutaneous nephrolithotomy. Fifty-eight adult patients were randomly divided into 2 groups preoperatively: Group RLB ( n  = 28) underwent ultrasound-guided retrolaminar block with 20 mL 0.5% bupivacaine. Group Control ( n  = 30) patients without block application. Primary outcome measure was abdominal Perlas score by ultrasound. Secondary outcome measures were time to first oral feeding, flatus, defecation, mobilization; duration of hospital stay; I-FEED (intake, feeling nauseated, emesis, physical examination, duration of symptoms) Score values; Patient Satisfaction Score; duration of postoperative rescue analgesia; Visual Analog Scale scores; intraoperative heart rate and mean arterial pressures. Patients in Group RLB exhibited significantly lower intraoperative opioid consumption (61.11 ± 21.18 µg, p  < 0.001) and a prolonged time to rescue analgesia (13.35 ± 4.06 min). VAS scores were consistently lower postoperatively, and patient satisfaction was high. Additionally, the Group RLB demonstrated reduced gastric content volume at 6 h postoperatively ( p  = 0.004) and a lower I-FEED score (2.35 ± 0.91, p  < 0.05), indicating improved gastrointestinal function. Heart rate and mean arterial pressure were also significantly reduced in Group RLB. Retrolaminar block has shown positive effects on postoperative pain management, gastrointestinal tract function and hemodynamic stability in PCNL. Lower opioid consumption, faster bowel movements and longer-lasting analgesic effect improved patient satisfaction and provided adequate postoperative pain control. These findings support the use of RLB as a safe and effective analgesic method in PCNL surgery.

To compare recovery quality after PCNL using ESPB, TPVB, and placebo. Randomized, double-blind, placebo-controlled trial. Sanming First Hospital affiliated to Fujian Medical University in China. 120 adults with American Society of Anesthesiologists physical status I–II scheduled for elective unilateral PCNL. Patients were randomized 1:1:1 to receive ESPB, TPVB, or placebo to test ESPB superiority over placebo and non-inferiority to TPVB. The primary outcome was Quality of Recovery-15 (QoR-15) score at 24 h. We tested ESPB superiority over placebo (8-point clinically important difference) and non-inferiority to TPVB (6-point margin). Secondary outcomes included pain scores, morphine consumption, time to first rescue analgesia, patient satisfaction, and adverse events. ESPB demonstrated significantly higher QoR-15 scores than placebo (median difference 11.0 points, 95% CI 7.0–14.0, P < 0.001) and met non-inferiority criteria versus TPVB (median difference 1.0 point, 95% CI −5.0 to 2.0). Both blocks reduced pain scores and morphine consumption by approximately 40% compared with placebo (P < 0.001), with no differences between techniques. Time to first rescue analgesia was prolonged with both blocks compared with placebo (P < 0.001). Patient satisfaction was higher with both blocks than with placebo (P < 0.001). No block-related complications occurred; postoperative adverse events were similar across groups. ESPB significantly improved recovery quality after PCNL, demonstrating superiority to placebo and non-inferiority to TPVB. ESPB represents an effective alternative to TPVB for PCNL analgesia, with comparable efficacy and safety. [Display omitted] •ESPB demonstrated non-inferiority to TPVB for recovery quality after percutaneous nephrolithotomy.•Both regional blocks reduced pain scores and opioid consumption by approximately 40 % versus placebo.•Time to first rescue analgesia was prolonged four-fold with regional blocks compared with placebo.•No block-related complications occurred with either ESPB or TPVB.