Endoscopically Controlled Access in Percutaneous Nephrolithotripsy, as a Method of Improving the Safety of Surgical Treatment

The objective: to сompare the safety and effectiveness of percutaneous access in mini percutaneous nephrolithotripsy (mPCNL) with combined control (ultrasound and fluoroscopy) versus mPCNL with multiparametric monitoring (combined and retrograde-endoscopic). Materials and methods. 100 randomly selected patients with solitary kidney stones (measuring 2.0 to 3.0 cm) were divided into two groups based on the type of percutaneous access. Group I: mPCNL with percutaneous access created using combined ultrasound and fluoroscopic guidance – 54 cases (54.0%); Group II: mPCNL with percutaneous tract formation using multiparametric control (ultrasound, fluoroscopic, and retrograde-endoscopic guidance) – 46 cases (46.0%). There were no statistically significant differences in patient demographics or stone characteristics between the groups. Results. In the mPCNL group, patients who underwent multiparametric-controlled percutaneous access showed a reduction in the difference between preoperative and postoperative hemoglobin levels: 8.31 ± 2.51 vs 12.05 ± 2.05 g/L (p < 0.05). There was also a reduction in intraoperative fluoroscopic exposure time: 1 min 40 sec ± 20 sec vs 2 min 30 sec ± 30 sec (p < 0.05); a shorter operative time: 79.02 ± 15.30 vs 88.33 ± 10.20 min (p < 0.05); and reduced postoperative hospital stays: 1.37 ± 0.30 vs 2.42 ± 0.20 days (p < 0.05). Additionally, in the multiparametric-controlled access group, there was a tendency toward a lower overall complication rate (10.87 vs 14.81%, p = 0.929), reduced pain levels (1.90 ± 1.12 vs 2.60 ± 1.34 points, p = 0.412), and improved stone-free rate (SFR) (97.83 vs 92.59%, p = 0.233). However, these differences did not reach statistical significance. Conclusions. High effectiveness of operations was observed when both classic-combined (ultrasound and fluoroscopy-guided) and multiparametric-controlled (ultrasound, fluoroscopy, and retrograde endoscopic) percutaneous access techniques were used during mPCNL. Multiparametric-controlled percutaneous access during mPCNL demonstrated a trend toward a reduction in the frequency of intraoperative complications with a significant reduction in blood loss due to additional visual control of the transparenchymal access. This approach minimizes trauma to the renal collecting system structures, particularly benefiting endourologists with limited experience in percutaneous surgery.