Super multiple-tract minimally invasive percutaneous nephrolithotomy in one session for treating complex renal stones: an initial experience

Background Complex kidney stones usually require multiple percutaneous tracts to remove the stone completely. This study was aim to evaluate the feasibility of super multiple-tract (≥ 5 tracts) minimally invasive percutaneous nephrolithotomy (Mini-PCNL) in one session for treating complex renal stones. Methods From March 2019 to August 2023, the perioperative clinical data of 35 patients with complex renal stones who underwent super multiple-tract Mini-PCNL in our institution were collected and analyzed, retrospectively. Results A total of 35 patients were included in this study. The mean stone size and burden were 78.9 ± 22.8 mm and 1953.4 ± 1150.4 mm ² , respectively. The mean S.T.O.N.E. score was 10.83, including 21 patients (60.0%) with scores ≥ 11 and the average Guy’s stone score was 3.49. The mean number of established tracts was 6.3 (range 5–13). The average surgery time and length of hospital stay were 149.8 minutes and 3.4 days, respectively. The mean serum creatinine was increased by 6.5 mol/L and the mean hemoglobin drop was 24.9 g/L. The postoperative complication rate was 25.7%, with severe complication (Clavien grade IV) in one case. The mean follow-up time was 3.5 months, and the average glomerular filtration rate was declined by 1.1 ± 8.7 ml/min. The stone free rate was 82.9% after one stage of super multiple-tract Mini-PCNL. Conclusion When applied by experienced urologists, super multiple-tract Mini-PCNL in one session is feasibility in enhancing the stone-free rate with acceptable morbidity in the treatment of some complex renal stones.