Is Non-Papillary Puncture in Ultrasound-Guided Standard-Access Percutaneous Nephrolithotomy Safe and Feasible for Complex Renal Stones?

<b><i>Purpose:</i></b> To investigate the safety and feasibility of non-papillary puncture in total ultrasound (US)-guided standard size access percutaneous nephrolithotomy (PCNL) for patients with complex renal stones. <b><i>Patients and Methods:</i></b> We retrospectively reviewed the charts of complex renal stones (Guy's scoring system 3-4) patients who had undergone standard size access PCNL in our department from January 2019 to October 2023 (<i>n</i> = 422). Renal abnormalities, history of PCNL and pyelolithotomy/nephrolithotomy, and multiple tracts PCNL were excluded. Two hundred A total of 218 eligible patients were finally enrolled. These patients were allocated to two groups according to puncture site: papillary (Group 1, <i>n</i> = 182) and non-papillary (Group 2, <i>n</i> = 36). All procedures were guided by total US. Single standard access (22-24 F) was achieved in all patients. Relevant patient characteristics, operative variables, and postoperative data were collected and analyzed, with a focus on the stone-free rate (SFR) and bleeding complications. <b><i>Results:</i></b> Successful percutaneous renal puncture was achieved in all patients. Patients' basic characteristics (gender, age, body mass index, stone size, surgical side) were similar between the two groups. The SFRs in the papillary puncture group were significantly higher than the non-papillary puncture group (81.3% <i>vs</i> 69.4%, <i>p</i> = 0.03). Hemoglobin loss in Group 2 is much more significant than in Group 1 (18.4 ± 5.4 g/L <i>vs</i> 10.4 ± 4.7 g/L, <i>p</i> = 0.02). Overall non-severe complication (Clavien-Dindo Grade 1-2) rates were significantly lower in Group 1 (<i>p</i> = 0.02, 0.03). The operative duration, transfusion rate, severe complication rate, and renal function changes show no significant difference between the two groups. <b><i>Conclusion:</i></b> US-guided PCNL through a standard-access tract is necessary for renal papilla puncture. Non-papillary puncture increases bleeding volume and reduces SFR, and should be avoided in complex stones whenever possible.