To compare perioperative outcomes, complications and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL).
This prospective multicentre study enrolled adults with normal kidneys undergoing SM-PCNL (14-22 Fr) across 30 international centres (March-November 2024). Patients were divided into laser (Group 1) and non-laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30-day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications.
After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non-laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30-day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single-step dilation (OR 3.05) and sheath sizes of 16.5-18 Fr (OR 1.98) or 20-22 Fr (OR 2.72) were associated with higher odds of stone-free status, while skin-to-stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non-metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications.
Both laser and non-laser lithotripsy are effective in SM-PCNL. Non-laser devices improve efficiency and lasers were preferentially used with 14-18 fr access tracts.
BJUI compass. 2025 Oct 08*** epublish ***
Angelo Cormio, Vineet Gauhar, Bhaskar K Somani, Jaisukh Kalathia, Nariman Gadzhiev, Marek Zawadzki, Mahmoud Laymon, Karl Tan, Gopal Ramdas Tak, Theodoros Tokas, Madhu Sudan Agrawal, Jean de la Rosette, Kremena Petkova, Kazumi Taguchi, Dmitriy Gorelov, Alexey G Martov, Leonardo Gomes Lopes, Mehmet Ilker Gökce, Wissam Kamal, Stefania Ferretti, Devang Desai, Yadgar Abduljabbar Shwani, Khi Yung Fong, Steffi Kar Kei Yuen, Andreas Skolarikos, Marcos Cepeda, Thomas R W Herrmann, Daniele Castellani
Department of Urology Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica Delle Marche Ancona Italy., European Association of Urology Section of Endourology Arnhem Netherlands., Fortune Urology Clinic, Botad Gujarat India., Department of Urology Saint-Petersburg State University Hospital Saint-Petersburg Russia., Urology Unit, St. Anna Hospital Piaseczno Poland., Department of Urology, Urology and Nephrology Center Mansoura University Mansoura Egypt., Department of Surgery, Section of Urology Veterans Memorial Medical Center Quezon City Republic of the Philippines., Department of Urology Asian Institute of Nephrology and Urology Hyderabad Telangana India., Department of Urology, Medical School, University General Hospital of Heraklion University of Crete Heraklion Greece., Department of Urology Pushpanjali Hospital & Research Centre Uttar Pradesh India., International School of Medicine Istanbul Medipol University Istanbul Turkiye., Department of Urology and Nephrology Military Medical Academy Sofia Bulgaria., Department of Urology University of Alabama at Birmingham Birmingham AL USA., Department of Urology Hospital Orizonti and Santa Casa de Belo Horizonte Minas Gerais Brazil., Department of Urology Ankara University School of Medicine Ankara Turkey., Urology Unit, King Fahd General Hospital Jeddah Saudi Arabia., Department of Urology University of Modena and Reggio Emilia Modena Italy., University of Queensland Queensland Australia., Erbil teaching hospital, Kurdistan Iraq., Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore.