The perioperative outcomes of papillary versus non-papillary access in percutaneous nephrolithotomy

Abstract

Objective: To compare the perioperative outcomes of papillary versus non-papillary access in percutaneous nephrolithotomy (PCNL), which is the ‘gold standard’ for managing large renal calculi. Patients and Methods: In this prospective, randomised trial, 70 patients with de novo renal stones amenable to PCNL were allocated to undergo either papillary (n = 35) or non-papillary (n = 35) access. Primary outcomes included haemoglobin drop and the need for blood transfusion. Secondary outcomes assessed were: operative time, stone-free rates (SFRs; initial and final), the need for auxiliary procedures, incidence and grading of complication rates. Results: There were no statistically significant differences between the papillary and non-papillary groups in terms of perioperative haemoglobin drop (P = 0.971) or transfusion rates (P = 0.69). Although the non-papillary group had a shorter mean operative time (83 vs 92 min, P = 0.103) and a marginally higher initial SFR (88.6% vs 82.9%, P = 0.495), these differences were not statistically significant. Final SFRs were similar (94.3% vs 97.1%, P = 0.555). Both groups experienced low and comparable complication rates, including fever, sepsis, and prolonged urinary leakage, with no significant difference between them. Conclusion: Both papillary and non-papillary access approaches in PCNL show comparable safety and efficacy. While non-papillary access was associated with a slight reduction in operative time and a higher SFR, these findings were not statistically significant.