Agrawal Madhu Sudan, Kumar Naveen, Mishra Dilip, Yadav Anurag, Sharma Laxmi Kant, Sharma Gaurav, Patel Sachin, Bai Diptiranjan
Institute of Urology and Renal Sciences, Pushpanjali Hospital and Research Centre, Agra, 282002, Uttar Pradesh, India.
Department of Urology, Pushpanjali Hospital and Research Centre, Agra, 282002, Uttar Pradesh, India.
Urolithiasis. 2025 Jun 30;53(1):132. doi: 10.1007/s00240-025-01804-2.
The rise in intra-renal pressure during Mini PCNL (percutaneous nephrolithotripsy) potentially leads to pyelovenous backflow and infectious complications. This prospective randomized study compares intra-renal pressure (IRP) in patients undergoing Mini PCNL (mPCNL) procedure with and without suction for renal stones. Suction mPCNL is expected to lower IRP by continuously aspirating irrigation fluid and stone fragments, thereby enhancing procedural safety. A total of 100 patients with kidney stones measuring 1-4 cm were randomized into two groups: Mini PCNL with suction (n = 50) and Mini PCNL without suction (n = 50). IRP was measured using a pressure transducer connected to a ureteral catheter. Key outcome measures included intra-renal pressure, stone-free rate, operative time, and complication rates. The suction mPCNL group demonstrated a significantly lower IRP (16.92 ± 2.93 mmHg) compared to the non-suction group (19.48 ± 4.77 mmHg, p = 0.002). The suction group also experienced shorter mean operative times (35.98 ± 14.10 min vs. 47.12 ± 15.36 min, p = 0.001) and lithotripsy times (19.50 ± 11.70 min vs. 26.24 ± 10.49 min, p = 0.003). The stone-free rate was higher in the suction group though this difference was not statistically significant. Likewise, the complication rates, including postoperative infection rates (fever and urosepsis) showed a downward trend in the suction group, however the difference was not statistically significant (p > 0.05). Suction mPCNL effectively reduces IRP, shortens operative time, maintains a comparable stone-free rate, making it a safer and more efficient alternative to traditional mPCNL. This study highlights the potential advantages of integrating suction mechanisms to control IRP and improve patient outcomes in PCNL procedures.
微创经皮肾镜取石术（Mini PCNL）期间肾内压力升高可能导致肾盂静脉逆流和感染性并发症。这项前瞻性随机研究比较了在有或没有吸引装置辅助的情况下进行Mini PCNL手术治疗肾结石患者的肾内压力（IRP）。预期吸引式Mini PCNL通过持续抽吸冲洗液和结石碎片来降低IRP，从而提高手术安全性。总共100例肾结石大小为1 - 4厘米的患者被随机分为两组：有吸引装置的Mini PCNL组（n = 50）和无吸引装置的Mini PCNL组（n = 50）。使用连接到输尿管导管的压力传感器测量IRP。主要观察指标包括肾内压力、结石清除率、手术时间和并发症发生率。与无吸引组（19.48±4.77 mmHg，p = 0.002）相比，有吸引装置的Mini PCNL组的IRP显著更低（16.92±2.93 mmHg）。有吸引装置组的平均手术时间也更短（35.98±14.10分钟对47.12±15.36分钟，p = 0.001）以及碎石时间更短（19.50±11.70分钟对26.24±10.49分钟，p = 0.003）。有吸引装置组的结石清除率更高，尽管这种差异无统计学意义。同样，包括术后感染率（发热和尿脓毒症）在内的并发症发生率在有吸引装置组呈下降趋势，然而差异无统计学意义（p＞0.05）。有吸引装置的Mini PCNL有效降低IRP，缩短手术时间，保持相当的结石清除率，使其成为传统Mini PCNL更安全、更有效的替代方法。本研究强调了在PCNL手术中整合吸引机制以控制IRP和改善患者预后的潜在优势。
