Reducing Major Complications in Percutaneous Nephrolithotomy Through Surgical Standardization: A Retrospective Evaluation of 100 Cases and Review of the Literature

Objective: This study aims to assess the effectiveness of standardized preoperative, intraoperative, and postoperative protocols in preventing major complications (Clavien-Dindo grades 3–5) during percutaneous nephrolithotomy (PNL) procedures performed with micro, mini, and standard techniques in our clinic. Materials and Methods: A total of 100 consecutive patients who underwent PNL for renal calculi between April 2022 and January 2024 were retrospectively evaluated. Surgical approaches included micro, mini, and standard PNL, all performed by a single experienced surgeon. Patient demographics, stone characteristics, procedural details, complications, and outcomes were systematically analyzed. Results: No major complications were observed across all procedures. Standardized measures—such as careful selection of minimally invasive techniques, use of vacuum-assisted renal sheaths, preoperative sterile urine cultures, controlled intrarenal pressure, and intraoperative flexible endoscopic evaluation—were instrumental in reducing risk. Minor complications occurred in 11% of cases (grade 1) and 6% (grade 2). Logistic regression analysis identified lower stone density and higher Guy’s stone scores as independent predictors of postoperative complications. Conclusion: Implementing a comprehensive and standardized surgical protocol significantly minimized the incidence of major complications in PNL procedures. These findings suggest that clinical pathways emphasizing meticulous planning, imaging-based entry strategies, pressure control, and intraoperative assessments can substantially improve safety profiles. Multicenter prospective studies are warranted to further validate these outcomes.