Propensity Score–matched Analysis of 30-day Outcomes of Suction Versus Nonsuction Mini Percutaneous Nephrolithotomy from a Real-World Multicenter Prospective Study: Collaboration Between the European Association of Urology Endourology Section and the Asian Urological Society of Endoluminal Surgery and Technology

Abstract

Background and objective: This study compares 30-d perioperative outcomes between suction mini percutaneous nephrolithotomy (S-mPCNL) and nonsuction mPCNL (NS-mPCNL). Methods: This prospective multicenter study involved 20 surgeons from 14 countries. The primary outcome was the 30-d stone free rate (SFR) on computed tomography. Propensity score matching (PSM) was used to adjust for baseline differences between the two groups. Multivariable logistic regression was used to evaluate factors associated with 100% SFR and the overall complication rate. Key findings and limitations: PSM for 1915 patients (1534 S-mPCNL, 381 NS-mPCNL) yielded a cohort of 664 S-mPCNL and 309 NS-mPCNL cases for analysis. Baseline and stone characteristics were well matched. The 30-d 100% SFR (grade A) was high in both groups and did not significantly differ (85% vs 87%; odds ratio [OR] 0.97, 95% confidence interval [CI] 0.63–1.49; p = 0.9). The S-mPCNL group had a shorter median operative time (43 vs 57 min), higher intraoperative SFR according to visual inspection or fluoroscopy (82% vs 70%), and lower blood transfusion rate (1.3% vs 3.6%). There was no between-group difference in infectious complications. Multivariable analysis revealed that stone volume (OR 0.93, 95% CI 0.87–0.99; p = 0.021) and single-step dilatation (OR 3.28, 95% CI 1.85–5.81; p < 0.001) were significantly associated with grade A SFR. Limitations include variability in practice. Conclusions and clinical implications: Suction during mPCNL improves intraoperative stone clearance rates and reduces the operative time, with no significant difference in 30-d SFR or infectious complications. Both S-mPCNL and NS-mPCNL achieve high rates of zero residual fragments.