The impact of antegrade guidewire positioning outside the external urethral meatus in supine PCNL: the through and through technique.

This study aims to evaluate the impact of through-and-through (T-T) guidewire positioning versus conventional guidewire positioning in percutaneous nephrolithotomy (PCNL) with endoscopic combined intrarenal surgery (ECIRS) on complication rates (CR), surgical outcomes, and predictors of post-operative complications. We analyzed data from patients who underwent PCNL in our institution. Patients were divided into the T-T group (guidewire positioned through the urethral meatus) and the No-T-T group (guidewire positioned within the renal pelvis or down the ureter). Pre-, peri-, and post-operative data were collected, including demographics, clinical characteristics, stone parameters, and surgical outcomes. Statistical analyses, including t-tests, chi-square tests, and logistic regression, were performed to compare outcomes and identify complication predictors. The T-T group exhibited a lower overall CR (28.57% vs. 53.68%, p < 0.05), a higher stone-free rate (SFR) (78.09% vs. 62.1%, p = 0.02), and resulted in reduced blood loss (∆Hb 1.30 g/dL vs. 1.73 g/dL, p < 0.05), radiation exposure time (RET) (383.1 vs. 469.1 s, p < 0.05), and hospital stay (HS) (3.97 vs. 4.8 days, p < 0.05). The T-T technique was a protective factor against complications (OR = 0.26, p < 0.05). In patients with high stone complexity, the T-T technique was associated with lower CR (34.78% vs. 61.5%, p = 0.03) and higher SFR (71.74% vs. 51.28%, p = 0.04). Higher BMI, positive urine culture, and hydronephrosis were predictors of increased complication risk. The T-T guidewire technique is associated with lower CR, higher SFR, reduced blood loss, and shorter HS. These findings suggest that the T-T technique may enhance surgical outcomes and should be considered a valuable approach in managing large renal calculi. Further studies are recommended to confirm these results.