A new modification of renal track creation in percutaneous nephrolithotomy (PCNL), a novel technique.

OBJECTIVES: The objective of the study is to compare our novel access creation technique and standard percutaneous nephrolithotomy (PCNL) in terms of perioperative outcomes.

PATIENTS AND METHODS: Sixty patients with partial or complete stag horn stones that were larger than 4 cm were the subjects of the prospective randomized clinical trial. Randomly, the patients were divided into two equal groups; group 1 (the novel group) was administered the novel technique. Using single-step Amplatz dilatation followed by the use of a modified laparoscope trocar 36 Fr as an access sheath with a side screw for suction and group 2 (control group) underwent standard PCNL. The preoperative evaluation of all patients included a comprehensive clinical evaluation, a normal X-ray of the kidney-ureter-bladder, and a computed tomography scan of the abdomen without contrast, and laboratory investigations. Data regarding the perioperative period were documented.

RESULTS: A significant difference was observed in the operative and puncture times between both groups, with Group 1 (the novel group) demonstrating shorter operative and puncture times than those of Group 2 (control group) (P = 0.001, 0.001). Group 1 (novel group) exhibited significantly reduced need for opioids for pain (P = 0.028), levels of bleeding necessitating blood transfusion, and residual fragments than group 2 (control group) (P < 0.05). Group 1 (novel group) experienced a significantly shorter hospital stay than Group 2 (control group) (P = 0.001).

CONCLUSIONS: We have developed a novel method for the safe and effective construction of PCNL tracks in the presence of large renal stones. The novel technique, when compared to the standard PCNL, had shorter operative time, puncture time, hospital stay, and less postoperative complications, with a higher satisfaction rate.