Comparing laser vs mechanical lithotripsy in suction mini-PCNL for kidney stone disease: A prospective multicentre study by the endourology section of EAU.

Objectives: To compare perioperative outcomes, complications and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL).

Subjects and methods: This prospective multicentre study enrolled adults with normal kidneys undergoing SM-PCNL (14-22 Fr) across 30 international centres (March-November 2024). Patients were divided into laser (Group 1) and non-laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30-day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications.

Results: After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non-laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30-day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single-step dilation (OR 3.05) and sheath sizes of 16.5-18 Fr (OR 1.98) or 20-22 Fr (OR 2.72) were associated with higher odds of stone-free status, while skin-to-stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non-metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications.

Conclusions: Both laser and non-laser lithotripsy are effective in SM-PCNL. Non-laser devices improve efficiency and lasers were preferentially used with 14-18 fr access tracts.