Comparison of Standard percutaneous nephrolithotomy with and without Flexible Nephroscopy in Complex Renal Stones

Background Complex renal stones (CRS) continue to be challenging in percutaneous nephrolithotomy (PCNL). Flexible nephroscopy (FN) may enhance intrarenal inspection and outcomes. Objective To compare standard PCNL versus PCNL with FN in patients with CRS regarding operative parameters, bleeding profile, postoperative pain, hospital stay, and residual stones. Patients and Methods: This is a prospective comparative single-center study including 72 patients with CRS treated at Ghazi Al-Hariri Hospital for Surgical Specialities. Patients were assigned into two groups according to surgical management: standard PCNL (n = 40) and PCNL with FN (n = 32). Operative time, fluoroscopy time, number of access tracts, blood loss, perioperative hemoglobin, pain score at 6 and 24 hours post-surgery, analgesia requirement, hospital stay, and residual stones at 1 week and 3 months were reported. Results Operative time and fluoroscopy time were significantly longer in the PCNL with FN group (112.0 ± 22.55 vs 93.23 ± 14.16 min; 7.98 ± 1.59 vs 6.19 ± 0.34 min). The standard PCNL group needed more multiple tracts (three tracts: 17.5% vs 0%). Estimated blood loss was significantly lower in PCNL with FN (248.16 ± 42.25 vs 274.1 ± 37.09 mL). Although preoperative hemoglobin (Hb) was comparable, postoperative Hb was significantly higher in the PCNL with FN group (12.13 ± 1.51 vs 11.54 ± 0.96 g/dL) with a smaller Hb dropping (0.91 ± 0.57 vs 1.71 ± 0.69 g/dL). Pain at 24-hour post-surgery was significantly lower in PCNL with FN (3.25 ± 0.76 vs 4.08 ± 0.94), and there were fewer patients required analgesia (34.38% vs 60%, p = 0.031). Furthermore, hospital stay was significantly shorter in PCNL with FN (2.75 ± 1.34 vs 4.0 ± 1.83 days). In contrast, residual stone was comparable between the two groups at 1 week and 3 months postoperatively with no significant differences Conclusion In CRS, adding FN to PCNL was associated with longer operative and fluoroscopy times, but it reduces access tracts, 24-hour postoperative pain and analgesia requirement, improves the bleeding profile, and shortened hospital stay, without a significant difference in residual stone rates up to 3 months.