Mini-percutaneous Nephrolithotomy: What are the Real Benefits Compared to Standard PCNL? Single-center Experience and Comparative Analysis with Literature
M. Belaghzal *
Department of Urology, Mohammed VI University Hospital, Tangier, Morocco.
Y. Retal
Department of Urology, Mohammed VI University Hospital, Tangier, Morocco.
Z. Bakkali Aissaoui
Department of Urology, Mohammed VI University Hospital, Tangier, Morocco.
A. Khallouk
Department of Urology, Mohammed VI University Hospital, Tangier, Morocco.
*Author to whom correspondence should be addressed.
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.
Keywords: Mini-percutaneous nephrolithotomy (mini-PCNL), Percutaneous nephrolithotomy (PCNL), urolithiasis, renal stones, stone-free rate, morbidity, complications, clavier–dindo classification, endourology, holmium laser