Standard Versus Mini Percutaneous Nephrolithotomy for Renal Stones

Comparison of the Outcome of Mini-Percutaneous Nephrolithotomy Versus Standard Percutaneous Nephrolithotomy in Renal Stones

Renal stone disease is a common urological condition associated with significant morbidity. Percutaneous nephrolithotomy (PCNL) is the standard treatment for renal stones larger than 2 cm. Although standard PCNL (Percutaneous nephrolithotomy) is associated with high stone-free rates, it carries a risk of complications such as bleeding and prolonged hospital stay. Mini percutaneous nephrolithotomy has been introduced as a less invasive alternative with the potential to reduce morbidity. However, evidence comparing outcomes between mini-PCNL (Percutaneous nephrolithotomy) and standard PCNL (Percutaneous nephrolithotomy) remains inconsistent, particularly in the local population. This randomized controlled trial aims to compare operative and postoperative outcomes of mini-PCNL versus standard PCNL in patients with renal stones.

Percutaneous nephrolithotomy is the preferred surgical intervention for large renal calculi. Despite its effectiveness, standard PCNL is associated with complications including hemorrhage, postoperative pain, and prolonged hospitalization. Mini-PCNL utilizes a smaller tract size, potentially reducing parenchymal injury and blood loss while maintaining adequate stone clearance. Previous studies have reported conflicting results regarding operative time, stone-free rates, and complications between the two techniques. Additionally, limited data are available from Pakistan. This randomized controlled trial will compare operative time, hemoglobin drop, stone clearance, postoperative fever, and length of hospital stay between mini-PCNL and standard PCNL, with the aim of identifying the safer and more effective approach for renal stone management.

Eligibility Criteria

Inclusion Criteria:

1. Patients aged 20 to 60 years
2. Both male and female participants
3. Single renal pelvic stone less than 30 mm in size
4. Diagnosis confirmed by intravenous urography and ultrasonography

Exclusion Criteria:

1. Coagulopathy (INR > 1.5)
2. Active urinary tract infection
3. Staghorn calculus
4. Renal structural anomalies
5. Polycystic kidney disease
6. Ectopic or transplanted kidney
7. Renal malignancy
8. Uncontrolled pyonephrosis
9. Chronic renal failure or chronic liver disease