We aim to evaluate the association between sheath size and outcomes in suction mini-percutaneous nephrolithotomy (SM-PCNL).
A prospective, multicentre study enrolled 1534 patients undergoing SM-PCNL from March to November 2024 across 30 centres. Patients were stratified into three groups: Group 1 (14-15 Fr, n = 780), Group 2 (16-18 Fr, n = 388), and Group 3 (20-22 Fr, n = 366). Primary outcome was 30-day stone-free rate (SFR) determined by non-contrast CT. Secondary outcomes included complications, operative times and hospital stay.
Group 3 achieved the highest zero residual fragment rate (92.6%) compared to Groups 2 (80.7%) and 1 (79.5%) (p < 0.001). Operative times were shortest in Group 3 (36 min) and longest in Group 2 (65 min). Larger sheaths were associated with significantly higher overall complication rates: Group 1 (7.6%), Group 2 (14.4%) and Group 3 (14.8%) (p < 0.001). Transfusion requirements increased with sheath size: 0% (Group 1), 1.5% (Group 2) and 3.3% (Group 3). Group 3 had exclusive pleural injuries requiring chest tubes (2.7%) and highest pelvicalyceal perforation rates (4.1% vs 1.3% in Group 2, 0% in Group 1). Larger sheath (16/18 Fr: OR 1.82; 21/22 Fr: OR 4.14) and single step dilation (OR 3.84) were associated with higher odds of zero residual fragments. Sheath size 21/22 Fr (OR 2.12) and increasing Guys stone score (score 2: OR 1.94; score 3: OR 3.51; score 4: OR 2.63 95% CI) were factors significantly associated with higher odds of overall complications.
Sheath selection in SM-PCNL requires balancing efficacy against safety. Larger sheaths (20-22 Fr) optimize stone clearance but increase complications. Smaller sheaths (14-15 Fr) offer superior safety for simple cases. Intermediate sizes (16-18 Fr) may represent an optimal compromise for moderately complex stones.
BJUI compass. 2025 Dec 29*** epublish ***
Vineet Gauhar, Bhaskar Somani, Steffi Kar-Kei Yuen, Kemal Sarica, Marek Zawadzki, Abhishek Singh, Khi Yung Fong, Angelo Cormio, Wei Zhu, Jaisukh Kalathia, Nariman Gadzhiev, Vigen Malkhasyan, Yadgar Shwani, Oriol Angerri Feu, Ben H Chew, Guohua Zheng, Thomas R W Herrmann, Daniele Castellani
Endourology Section of the European Association of Urology Arnhem The Netherlands., Department of Urology, School of Medicine Biruni University İstanbul Turkey., Urology Unit St. Anna Hospital Piaseczno Poland., Urology Unit Muljibhai Patel Urological Hospital Nadiad Gujarat India., Department of Urology Sengkang General Hospital Singapore Singapore., Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia University of Foggia Foggia Italy., Department of Urology The First Affiliated Hospital of Guangzhou Medical University Guangzhou China., Fortune Urology Clinic Botad Gujarat India., Department of Urology Saint-Petersburg State University Hospital Saint-Petersburg Russia., Department of Urology Moscow Urology Center, Botkin Hospital Moscow Russia., Urology Unit Hawler Medical University Erbil Iraq., Department of Urology University of British Columbia Vancouver Canada.