Mini-PCNL with a vacuum-assisted access sheath for renal calculi with pyonephrosis in the second stage

To compare the safety and efficacy of mini-PCNL with vacuum-assisted access sheath in the second-stage treatment of renal calculi with obstructive pyonephrosis.A prospective, randomized clinical study was performed at our hospital from May 2020 to May 2022. Patients with pyogenic drainage fluid who needed percutaneous nephrolithotomy were randomized to the peel-away assisted mini-PCNL group (group A) and the vacuum-assisted mini-PCNL group (group B). Demographic information, clinical features, and perioperative period data were collected.Fifty mini-PCNLs using a single 16 F access sheath were performed in all patients of our study. All patients underwent second-stage surgical treatment. Demographic information and clinical features were not significantly different between groups A and B. But compared with group A, patients in group B had a short operative time (60.60 ± 7.68 min vs. 82.20 ± 14 min p = 0.018), a lower post-operative fever rate (8% vs. 32% p = 0.034), and a higher stone-free rate 2 d after the operation (88% vs. 64% p = 0.047). There was no significant difference between the two groups in blood transfusion, HB deficit, PCT after the operation, total hospitalization costs, stone-free rate 30 d after the operation, and length of stay or stay post-operative. And no serious complications after the operation occurred in either group.Mini-PCNL with vacuum-assisted access sheath is a safe and efficient treatment for patients with calculi-related obstructive pyonephrosis in the second stage.