Safety and efficacy of ultramini percutaneous nephrolithotomy in comparison with standard percutaneous nephrolithotomy for management of renal calyceal calculi 1–2 cm in size: a comparative randomized prospective study

Background
The management of renal stones, one of the most prevalent urological issues, can be accomplished using a variety of techniques, including flexible ureteroscopy, laser lithotripsy, extracorporeal shockwave lithotripsy, standard percutaneous nephrolithotomy (S-PCNL), and mini and ultramini percutaneous nephrolithotomy (UM-PCNL), Despite the rising stone clearance rates, S-PCNL remains the therapy of choice for managing renal calculi in spite of its higher complication rate.
Aim
The purpose of this study was to compare the differences between the two procedures in terms of stone-free rate, the length of the procedure, the length of the hospital stay, the cost of the procedure, and any operative complications such as blood loss, the requirement for blood transfusions, and extravasation or urine leakage.
Patients and methods
This comparative study was conducted in Ain Shams University Hospitals from January 2020 till January 2022 and included 60 patients with renal calyceal stones. Their age ranged from 18 to 60 years. They were divided into two groups, with 30 patients in each group: one of them underwent S-PCNL and the other one underwent UM-PCNL.
Results
When compared with PCNL, UM-PCNL is a viable alternative for the management of renal stones. In group A (PCNL), the stone-free rate was 96.7%, whereas in group B, the rate was 90%. Only 3.3% of patients in group B experienced postoperative fever, compared with 10% of patients in group A. In group A, the mean operating time was 71.40±24.02 min, but in group B, it was 108.73±41.61 min. In group A, the mean hospital stay was 64.80±20.14 h, but in group B, it was 42.53±13.23 h. The mean cost in group A was 11091±644.64 pounds, whereas it was 14 890±1098.26 pounds in group B.
Conclusion
The gold standard method for treating renal stones with a high stone-free rate is still S-PCNL. Although S-PCNL can cause serious consequences including bleeding and visceral damage, their frequency is relatively low. An appropriate substitute for S-PCNL in the treatment of renal stones is UM-PCNL. Very low complication rates and a shorter hospital stay make it safer. Surgeons must put into consideration many factors before selection of the procedure (PCNL vs. UM-PCNL), such as stone size, distribution, presence of comorbidity, patient preference, hospital equipment, surgeon experience, and operation cost.