Mini-percutaneous Nephrolithotomy: What are the Real Benefits Compared to Standard PCNL? Single-center Experience and Comparative Analysis with Literature

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard treatment for renal stones ≥ 2 cm. However, the size of the percutaneous tract is associated with non-negligible morbidity, particularly bleeding complications. The miniaturization of instruments has led to the development of mini-PCNL, aiming to reduce parenchymal injury while maintaining satisfactory efficacy. Objective: To evaluate the efficacy and morbidity of mini-PCNL in our clinical practice and to compare our results with those reported in the literature. Materials and Methods: This is a retrospective single-center study including 48 patients who underwent mini-PCNL between 2023 and 2026. The analyzed parameters included demographic data, stone characteristics (size, location, density in Hounsfield units), operative time, stone-free rate, complications according to the Clavier–Dindo classification, transfusion rate, and length of hospital stay. Results: The mean age was 53.6 years (range: 24–75 years), with a female predominance (59%). Stones were radiopaque in 94% of cases, with a density >1000 Hounsfield units in 52.6% of cases. Stones larger than 20 mm accounted for 58.8% of cases. Operative time ranged between 100 and 120 minutes in 97% of cases. The mean length of hospital stay was 2–3 days. The initial stone-free rate (SFR) was 79.4%. Additional treatment (flexible ureteroscopy or extracorporeal shock wave lithotripsy) was required in 20.6% of patients. Hemorrhagic complications and transfusion rate were 4.2%, while infectious complications occurred in 2.1% of cases. Conclusion: Mini-percutaneous nephrolithotomy (mini-PCNL) is an effective and less invasive technique, allowing a reduction in hemorrhagic morbidity and length of hospital stay. The stone-free rate remains satisfactory despite a high proportion of large and dense stones. Careful patient selection remains essential to optimize outcomes. Standard PCNL still retains its role in the management of large and complex stones.