Safety and efficacy of total tubeless mini-PCNL in the management of renal stones: prospective observational study.

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard practice for the treatment of large renal stones. There has been a gradual shift from "standard" PCNL to increasingly less invasive forms of PCNL in recent years. Innovations in both the technology and techniques of PCNL continue to improve the safety and efficacy of renal stone surgery. Total tubeless mini-PCNL (TTmPCNL) is a minimally invasive form of PCNL where the risks and benefits are still under evaluation. The aim of this study was to assess the safety and efficacy of TTmPCNL.

Methods: This observational study was conducted in the Urology unit, Department of Surgery, Nepalese Army Institute of Health Sciences (NAIHS), from January 2025 to May 2025. All patients fulfilling the inclusion criteria (stone size 10-30 mm, no urinary tract infection, age ≥ 18 years) underwent prone TTmPCNL utilising pneumatic lithotripsy under fluoroscope guidance were enrolled in the study. Follow-up was performed to determine the stone-free rate (SFR), incidence of postoperative complications, and length of hospital stay.

Results: A total of 44 TTmPCNL procedures were performed in patients aged 45.1 ± 13 years (mean ± standard deviation (SD)). The size of the renal stone was 19.7 ± 4.9 mm (mean ± SD). Stone complexity burden was assessed using Guy's stone scoring system (GSS). The postoperative decrease in haemoglobin was 1.32 ± 0.47 gm/dl (mean ± SD), the postoperative complication rate was 15.9%, and the SFR was 95.5%. The length of hospital stay was 1.5 ± 0.6 (mean ± SD) days. Significant differences in the stone-free rate (p = 0.02) and incidence of postoperative complications (0.008) were noted among different GSS groups.

Conclusion: TTmPCNL is a safe and effective surgical treatment option for the treatment of carefully selected renal stone disease, with an acceptable complication rate, short hospital stays, and high SFR.