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We conducted a prospective, randomized study to compare the safety and efficacy of using a conventional nephrostomy sheath (CNS) versus a minimally invasive suction-evacuation nephrostomy sheath (SENS) for treating partial staghorn stones. Eighty-six patients with partial staghorn stones were randomly assigned into two groups, with 43 patients in each group. One group underwent standard percutaneous nephrolithotomy (sPCNL) using CNS, whereas the other group underwent minimally invasive percutaneous nephrolithotomy (mPCNL) with SENS. Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analyzed.The patient demographics and stone characteristics were similar in both groups. The SENS group had significantly lower peak and mean intrarenal pressure (IRP) during the procedure. The stone-free rate (SFR) was comparable between groups. The SENS group removed stones more efficiently, with shorter treatment time and less frequent use of the stone extractor. Lower IRP and shorter treatment time led to fewer postoperative complications.mPCNL with SENS results in lower IRP, faster stone removal, and reduced use of stone forceps while preserving SFR and safety.

Purpose To assess the safety, efficacy, and cost-effectiveness of flexible mini-percutaneous nephrolithotomy (F-mPCNL) in managing nephrolithiasis compared to retrograde intrarenal surgery (RIRS). Methods 130 adult patients with renal stones (1.5–3 cm) were randomized to F-mPCNL or RIRS. The stone-free rate (SFR) was our primary outcome. Secondary outcomes were the operative time, fluoroscopy time, DJ stent insertion rate, auxiliary procedure needed, hospital stay, complications rate, total cost, and quality of life for both procedures. Results out of 130 patients in our study, 125 were evaluated and completed the follow-up period. Preoperative data was similar in both groups including stone characteristics. F-mPCNL showed a better SFR of 95.1% compared to 77.8% in the RIRS group (p-value˂0.001), this was associated with less need for additional procedures. F-mPCNL was associated with a shorter operation time of 47.60 ± 14.54 min compared to 59.30 ± 20.10 min in the RIRS group (p-value˂0.001). F-mPCNL showed less radiational exposure and less need for DJ stent insertion than RIRS. The overall complication rate was comparable in both groups, postoperative pain, need for extra doses of analgesics, and hospital stay were higher in the F-mPCNL group. In our study, F-mPCNL was shown to be more cost-effective than RIRS. Conclusion F-mPCNL showed a superior SFR in treating renal stones compared to RIRS in a single session, with less need for auxiliary procedures, shorter operative time, less radiational exposure, and better quality of life. However, it was associated with slightly more hospital stay and postoperative pain compared to RIRS.

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 To prospectively evaluate the efficacy and safety of RIRS, SWL and PCNL for lower calyceal stones sized 1–2 cm. Materials and methods Patients with a single lower calyceal stone with an evidence of a CT diameter between 1 and 2 cm were enrolled in this multicenter, randomized, unblinded, clinical trial study. Patients were randomized into three groups: group A: SWL (194 pts); group B: RIRS (207 pts); group C: PCNL (181 pts). Patients were evaluated with KUB radiography (US for uric acid stones) at day 10 and a CT scan after 3 months. The CONSORT 2010 statement was adhered to where possible. The collected data were analyzed. Results The mean stone size was 13.78 mm in group A, 14.82 mm in group B and 15.23 mm in group C ( p  = 0.34). Group C compared to group B showed longer operative time [72.3 vs. 55.8 min ( p  = 0.082)], fluoroscopic time [175.6 vs. 31.8 min ( p  = 0.004)] and hospital stay [3.7 vs. 1.3 days ( p  = 0.039)]. The overall stone-free rate (SFR) was 61.8% for group A, 82.1% for group B and 87.3% for group C. The re-treatment rate was significantly higher in group A compared to the other two groups, 61.3% ( p  < 0.05). The auxiliary procedure rate was comparable for groups A and B and lower for group C ( p  < 0.05). The complication rate was 6.7, 14.5 and 19.3% for groups A, B and C, respectively. Conclusions RIRS and PCNL were more effective than SWL to obtain a better SFR and less auxiliary and re-treatment rate in single lower calyceal stone with a CT diameter between 1 and 2 cm. RIRS compared to PCNL offers the best outcome in terms of procedure length, radiation exposure and hospital stay. ISRCTN 55546280.

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.

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).

We performed a comparative analysis of intelligent pressure-controlled ureteroscopic lithotripsy (IRIRS) and intelligent pressure-controlled microchannel percutaneous nephrolithotomy (IMPCNL) to treat 2–3 cm renal calculi. Patients ( n  = 140) with 2–3 cm renal calculi were randomly divided into the IRIRS and IMPCNL groups ( n  = 70/group). Surgical time, length of hospital stays, stone clearance rate, decrease in hemoglobin level, postoperative pain score, and incidence of complications were compared between groups. The IRIRS group had significantly longer operative durations than the IMPCNL group (average: 58.3 ± 7.4 vs. 52.5 ± 6.8 min). Stone clearance rates at 4 weeks postoperatively were 90.0% and 92.8% in the IRIRS and IMPCNL groups, respectively ( P  > 0.05). The IRIRS group had shorter hospital stays than the IMPCNL group (1.9 ± 0.3 vs. 3.2 ± 0.4 days). Intraoperative hemoglobin levels decreased more in the IMPCNL (1.03 ± 0.12 g/dL) than in the IRIRS (0.25 ± 0.06 g/dL, P  < 0.001) group. Two and one cases in the IRIRS and IMPCNL group, respectively, experienced postoperative fever. The overall complication incidence did not significantly differ (12.9% IRIRS and 15.7% IMPCNL; P  > 0.05). IRIRS and IMPCNL are safe, effective interventions for 2–3 cm renal calculi. Given its minimally invasive nature and positive operative safety outcomes, IRIRS has promising future applications.

To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with impacted upper ureteral stones (IUUS). The study included 189 patients, of which 95 were included in the FV-UAS group and 94 in the MPCNL group. The primary study outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary outcomes included the total SFRs 1 month postoperatively, operative time, reduction in hemoglobin levels, length of postoperative hospital stay, improvement in the quality of life as measured by the QoL score, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. There was no obvious difference between two groups in patients’ demographics and preoperative clinical characteristics ( P  > 0.05). The mean decrease in hemoglobin was significantly lower in the FV-UAS group than in the MPCNL group (5.1 vs. 14.7 g/L, P  < 0.001). Similarly, the FV-UAS group had a shorter average hospital stay than the MPCNL group (2.7 vs. 4.9 days, P  < 0.001). However, SFRs at the first postoperative day and 4 weeks postoperatively were statistically similar between the two groups ( P  > 0.05). QoL improvement, measured by the QoL score, was significantly higher in the FV-UAS group than in the MPCNL group (32.5 vs. 27.1, P  < 0.001). At 3 months postoperatively, the difference between two groups in the terms of ureteral stricture was not statistically significant ( P  > 0.05). Notablely, the overall rate of postoperative complications was markedly lower in the FV-UAS group than in the MPCNL group ( P  < 0.001). Our study revealed that RIRS with FV-UAS is a promising approach to treat IUUS, achieving satisfactory SFRs compared to MPCNL and notable improvements in QoL with a low complication rate.

The aim is to compare the efficacy and safety between single percutaneous nephrolithotomy (sPNL) and antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (aPNL) for the treatment of staghorn calculi. A prospective randomized controlled study was conducted at the Second Hospital of Tianjin Medical University. A total of 160 eligible patients were included, with 81 in the sPNL group and 79 in the aPNL group. The study first compared the overall differences between sPNL and aPNL. Then, the patients were divided into two subgroups: Group 1 (with less than 5 stone branches) and Group 2 (with 5 or more stone branches), and the differences between the two subgroups were further analyzed. The results showed that aPNL had a higher stone-free rate (SFR) and required fewer percutaneous tracts, with a shorter operation time compared to sPNL (P < 0.05). Moreover, aPNL significantly reduced the need for staged surgery, particularly in patients with 5 or more stone branches. Moreover, there were no significant differences in the changes of hemoglobin levels and the need for blood transfusions between the sPNL and aPNL groups, and the incidence of multiple tracts was lower in the aPNL group. The two groups showed comparable rates of perioperative complications. We concluded that aPNL resulted in a higher SFR for staghorn calculi, and required fewer multiple percutaneous tracts, reduced the need for staged surgery, and had a shorter operative time than PNL alone, especially for patients with 5 or more stone branches. Furthermore, aPNL did not increase the incidence of surgical complications.