Direct-guided punction percutaneous nephrolitothomy versus standard percutaneous nephrolitothomy

Introduction. Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treating renal stones larger than 2 centimetres. The initial stage of PCNL involves retrograde catheterisation of the pelvicalyceal system (PCS) with contrast enhancement. Direct-guided puncture is a modification of standard PCNL, where puncture of the PCS is performed without retrograde enhancement of the PCS.

Objective. To compare the efficacy and safety of standard PCNL (miniPCNL/mPCNL) versus direct-guided puncture PCNL (dgPCNL).

Materials & methods. The study involved 67 patients who were recruited between September 2021 and March 2023. They were divided into two groups. Group 1 (n = 35) underwent standard PCNL, while group 2 (n = 32) received dgPCNL. We compared the following parameters: surgery duration and puncture time, visualization (using the Likert scale), stone-free rate (SFR), blood loss (post-op haemoglobin level decrease), renal function (post-op creatinine variations), and postoperative complications. To assess SFR, patients underwent abdominal computed tomography (CT) on the first post-op day. Postoperative complications were assessed using the Clavien-Dindo classification.

Results. The average surgery time in group 2 was 16 minutes, which was significantly less than that in group 1 (p < 0.001). We believe this reduction is due to the absence of the first stage. The puncture time did not differ between the two groups (p = 0.739), with an average puncture time of 2 minutes. There was no significant difference in SFR between the groups, with 91.4% in group 1 and 93.8% in group 2 (p > 0.999). Similarly, there were no significant differences in haemoglobin loss and creatinine changes between the groups (p = 0.32 and p = 0.442, respectively). No severe complications were observed, as classified by Clavien-Dindo III and IV.

 Conclusion. dgPCNL is safe and effective compared to standard PCNL, offering the advantage of reduced operative time. Blood transfusions were not required in either group.

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