Renal stones in anomalous kidneys pose surgical challenges due to altered anatomy. Miniaturized percutaneous nephrolithotomy (mini-PCNL) reduces morbidity, but concerns remain about stone-free rates (SFRs) and infection. Suction-assisted mini-PCNL (SM-PCNL) enhances fragment removal and controls intrarenal pressure, but its role in anomalous kidneys is unclear.
To evaluate perioperative outcomes of SM-PCNL in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies.
This prospective study across 15 centers (January-December 2024) included 287 adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. SFR was assessed via a 30-day non-contrast CT: 100% stone-free (Grade A), residual fragments ≤4 mm (Grade B), or >4 mm/multiple (Grade C, requiring reintervention).
Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with holmium laser (50.9%), thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative clearance was 95.4%. At 30 days, 93.4% achieved Grade A, 5.6% Grade B, and 1.0% required reintervention. Complications were low; 0.7% had sepsis requiring intensive care unit admission. No transfusions or pleural injuries occurred.
SM-PCNL using 18F suction sheaths with laser in a single stage achieved 93.4% complete SFR with negligible complications and minimal reintervention.
Journal of endourology. 2026 Feb 06 [Epub ahead of print]
Vineet Gauhar, Ee Jean Lim, Bhaskar Kumar Somani, Jaisukh Kalathia, Edgar Beltrán-Suárez, Gadzhiev Nariman, Mahmoud Laymon, Kremena Petkova, Esteban Acuna, Mohamed Amine Lakmichi, Khi Yung Fong, Marek Zawadzki, Nitesh Kumar, Amish Mehta, Roy Zen Sing Teng, Gopal Ramdas Tak, Alexey G Martov, Marcos Cepeda, Vigen Malkhasyan, Arun Chawla, Daniele Castellani, Thomas R W Herrmann, Steffi Kar Kei Yuen
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Department of Urology, Singapore General Hospital, Singapore, Singapore., University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom., Department of Urology and Kidney Transplantation, Fortune Urology Clinic, India., Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico, Mexico., Department of Urology, St. Petersburg State University Hospital, St. Petersburg, Russia Federation., Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria., Department of Urology, Instituition Hospital Provincial de Ovalle, Ovalle, Coquimbo, Chile., Department of Urology, University Hospital Mohammed the VIth, Faculty of Medicine, Cadi Ayyad University, Marrakesh, Morocco., Urology Unit, St. Anna Hospital, Piaseczno, Poland., Department of Urology, Ford Hospital and Research Centre, Patna, Bihar, India., B T Savani Kidney Hospital, Rajkot, Gujarat, India., Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India., Department of Urology and Andrology, IP P E of A.I. Burnazyan, SSC FMBC, FMBA of Russia, Moscow, Russia., Department of Urology, Hospital Universitario Río Hortega, Valladolid, Spain., Department of Urology, Moscow Urology Centre, Botkin Hospital, Moscow, Russia., Urology and Renal Transplant Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India., Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Ancona, Italy., Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland., Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China.
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