Comparative Analysis of the Safety and Efficacy of Endoscopy-Assisted Supine Percutaneous Nephrolithotomy Versus Standard Supine Percutaneous Nephrolithotomy: A Randomized Prospective Study.

OBJECTIVE: To compare the safety and efficacy of endoscopy-assisted supine percutaneous nephrolithotomy (ePNL) with standard supine percutaneous nephrolithotomy (sPNL). MATERIALS AND METHODS: This study included patients aged over 18 with a stone size of ≥2 cm, an American Association of Anesthesiology score of ≤3, and a body mass index of ≤35 who underwent ePNL or sPNL at our hospital between February 2021 and August 2021. Eligible patients, selected based on inclusion and exclusion criteria, were randomized using a computer-generated random table. Perioperative and postoperative data were compared between the two groups. RESULTS: A total of 60 patients were included in the study. Demographic data and stone characteristics were similar between the groups. The access fluoroscopy time (AFT) was comparable between the groups; however, the total fluoroscopy time (TFT) was significantly shorter in the ePNL group (31.5 seconds vs. 197.5 seconds, p<0.0001). The amount of bleeding, assessed by hemoglobin drop, was higher in the sPNL group (p=0.038). The success rate of guidewire placement into the ureter after access was higher in the supine ePNL group compared to the sPNL group (66.6% vs. 36.6%, p=0.038). There was no statistically significant difference in overall complication rates between the groups (p=0.272). Stone-free rates were 86.6% for ePNL and 80% for sPNL (p=0.488). CONCLUSION: The ePNL method is a safe and effective technique characterized by less bleeding, shorter fluoroscopy time, and successful guidewire placement into the ureter, with similar success and complication rates to sPNL.