This study compares 30-d perioperative outcomes between suction mini percutaneous nephrolithotomy (S-mPCNL) and nonsuction mPCNL (NS-mPCNL).
This prospective multicenter study involved 20 surgeons from 14 countries. The primary outcome was the 30-d stone free rate (SFR) on computed tomography. Propensity score matching (PSM) was used to adjust for baseline differences between the two groups. Multivariable logistic regression was used to evaluate factors associated with 100% SFR and the overall complication rate.
PSM for 1915 patients (1534 S-mPCNL, 381 NS-mPCNL) yielded a cohort of 664 S-mPCNL and 309 NS-mPCNL cases for analysis. Baseline and stone characteristics were well matched. The 30-d 100% SFR (grade A) was high in both groups and did not significantly differ (85% vs 87%; odds ratio [OR] 0.97, 95% confidence interval [CI] 0.63-1.49; p = 0.9). The S-mPCNL group had a shorter median operative time (43 vs 57 min), higher intraoperative SFR according to visual inspection or fluoroscopy (82% vs 70%), and lower blood transfusion rate (1.3% vs 3.6%). There was no between-group difference in infectious complications. Multivariable analysis revealed that stone volume (OR 0.93, 95% CI 0.87-0.99; p = 0.021) and single-step dilatation (OR 3.28, 95% CI 1.85-5.81; p < 0.001) were significantly associated with grade A SFR. Limitations include variability in practice.
Suction during mPCNL improves intraoperative stone clearance rates and reduces the operative time, with no significant difference in 30-d SFR or infectious complications. Both S-mPCNL and NS-mPCNL achieve high rates of zero residual fragments.
European urology focus. 2025 Dec 19 [Epub ahead of print]
Steffi Kar Kei Yuen, Gregory Xiang Wen Pek, Thomas Herrmann, Daniele Castellani, Khi Yung Fong, Jaisukh Kalathia, Wei Zhu, Gopal Ramdas Tak, Marcos Cepeda, Nariman Gadzhiev, Vigen Malkhasyan, Maher Al Hadithi, Rajesh Kukreja, Arun Chawla, Madhu Sudan Agrawal, Chandra Mohan Vaddi, Takaaki Inoue, Venkatsubramaniam Dhandapani, Nebil Akdogan, Tzevat Tefik, Nitesh Kumar, Kremena Petkova, Abu Baker, Karl Marvin Tan, Chinnakhet Ketsuwan, Mahmoud Laymon, Kemal Sarica, Mohamed Omar, Alexey Martov, Guohua Zeng, Bhaskar Kumar Somani, Vineet Gauhar
S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China. Electronic address: ., Department of Urology, Ng Teng Fong General Hospital, Singapore., Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Switzerland; Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa; Hannover Medical School, Hannover, Germany., Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Ancona, Italy., Department of Urology, Singapore General Hospital, Singapore., Fortune Urology Clinic, Botad, India., Department of Urology and Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India., Department of Endourology, Laparoscopy and Robot-Assisted Surgery, Río Hortega University Hospital, Valladolid, Spain., Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia., Endourology Department, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia., Department of Urology, Al Ramady Hospital, Anbar, Iraq., Urocare Hospital, Indore, Madhya Pradesh, India., Department of Urology and Renal Transplant, Kasturba Medical College, Manipal, India., Institute of Urology and Renal Sciences, Pushpanjali Hospital and Research Centre, Agra, India., Department of Urology, Preeti Urology and Kidney Hospital, Remedy Hospital LN, Hyderabad, India., Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe, Japan., Department of Urology, Asian Institute of Nephrology and Urology, Chennai, India., Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey., Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey., Ford Hospital and Research Centre, Patna, India., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Urology Section, Department of Surgery, Hazm Mebaireek General Hospital, Doha, Qatar., Department of Urology, Veterans Memorial Medical Center, Quezon City, Philippines., Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand., Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Department of Urology, Biruni University Medical School, Istanbul, Turkey., Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt., Department of Urology and Andrology, A.I. Burnazyan Federal Medical Biophysical Center, Moscow, Russia., Department of Urology, University Hospital Southampton, NHS Trust, Southampton, UK., S.H. Ho Urology Centre, Department of Surgery, Chinese University of Hong Kong, Hong Kong, China.