The current standing of standard PCNL in the era of miniaturization.

Abstract

Objective: To evaluate how standard operating procedures (SOPs), modification in puncture techniques, advancements in preoperative imaging to better understand calyceal anatomy have revitalized standard percutaneous nephrolithotomy (PCNL) for large kidney stones (>2.5 cm).

Methods: At our center, renal stones are managed with extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) according to stone characteristics and patient profile. Renal stones larger than 2.5 cm are managed with standard PCNL. In this retrospective study patients undergoing standard PCNL at a tertiary healthcare center from January 2018 to December 2023 having complete records were included. Data on demographics, stone characteristics, operative details, and outcomes were assessed using SPSS v26, with ethical approval ensuring confidentiality.

Results: A total of 766 patients were included. Mean age was 43.75 ± 16.0 years; 69.7% were male. Mean stone size was 3.8 ± 1.2 cm, with 46.7% complex (Guy's Stone Score [GSS] ⩾ 2). Using a 24 ± 3 Fr sheath and 1.3 tracts per procedure, operative time averaged 92.5 ± 20.3 min. Stone clearance was 91.3%, with significant intraoperative bleeding (requiring transfusion) in 1.7%. Overall complication rate was 16.4%, and hospital stay averaged 3.6 ± 1.2 days; 8.7% required additional interventions, including RIRS in 44.3% of those cases.

Conclusion: Modern standard PCNL achieves high clearance (91.3%) with minimal morbidity, reaffirming its role for large stones despite mini-PCNL's rise.