The optical puncture combined standard percutaneous nephrolithotomy versus the conventional percutaneous nephrolithotomy for kidney stones without hydronephrosis: a comparative study

To compare the efficacy and safety of optical puncture combined with standard percutaneous nephrolithotomy (PNL) and conventional PNL for the treatment of patients with complex kidney stones with no or mild hydronephrosis.

We retrospectively reviewed the data on patients with complex kidney stones treated by PNL in our hospital between May 2019 and February 2022. The patients were divided into two groups according to the puncture techniques applied. In the optical puncture group, 40 patients underwent optical puncture combined with standard PNL. In the control group, 44 patients underwent conventional standard PNL. The demographics and perioperative parameters were analyzed between the two groups.

There mean puncture durations were significantly shorter in the optical puncture group (8.2 ± 2.16 min) than in the control group (14.0 ± 6.76 min) (P = 0.001). The re-puncture rates were lower in the optical puncture group (5%) compared with the control group (20.5%) (P = 0.036). The access loss rate in the optical puncture group (2.5%) was significantly lower than that in the control group (11.36%) (P = 0.037). The mean hemoglobin drop was significantly lower in the optical puncture group (12.6 ± 5.36 g/L) compared with the control group (22.3 ± 11.61 g/L) (P = 0.001). The mean hospital stay was significantly shorter in the optical puncture group (3.9 ± 1.65d) compared with the control group (5.1 ± 2.10d) (P = 0.042). The primary stone-free rate in the optical puncture group (87.5%) was similar to the control group (84.1%) (P = 0.656). The overall stone-free rates were 95% in the optical puncture group and 93.2% in the control group (P = 0.725). There were significantly more patients in the control group (18.2%) who suffered collecting system injury than in the optical puncture group (2.5%) (P = 0.020). There were no significant differences between the two groups in terms of blood transfusion (P = 0.292), fever (P = 0.696) and urosepsis (P = 0.946).

We demonstrated that optical puncture combined with standard PNL could increase the precision and success rate of puncture, and reduce the access-related complications in patients with complex kidney stones without hydronephrosis.