Comparing the outcomes of non-papillary versus papillary mini-percutaneous nephrolithotomy for treatment of multiple renal stones: a prospective randomized study.

Papillary puncture is commonly recommended in percutaneous nephrolithotomy (PCNL) because it is thought to reduce the risk of vascular injury. In patients with multiple renal stones, however, calyceal anatomy and stone distribution can make a strict papillary approach difficult. Non-papillary access may be a practical alternative during mini-PCNL, but its safety and effectiveness remain debated. This study compared non-papillary and papillary access in mini-PCNL for multiple renal stones. This prospective randomized study enrolled 108 patients with multiple renal calculi. Patients were allocated to non-papillary access (n = 53) or papillary access (n = 55). All procedures were performed as mini-PCNL using an 18-Fr tract and holmium: YAG laser lithotripsy. Study outcomes included operative time, hemoglobin drop, stone-free rate (SFR), and perioperative complications. The non-papillary group had a significantly shorter operative time (49 ± 11 min vs. 58 ± 11 min; p < 0.001) as well as shorter fluoroscopy time (median 2.5 vs. 3.3 min; p < 0.001). Single access was achieved in 100% of non-papillary cases compared to 78.2% of papillary cases (p < 0.001). Hemoglobin drop was comparable (mean difference 0.10 g/dL; 95% CI: - 0.24 to 0.45) demonstrating non-inferiority. SFR was higher in the non-papillary group (69.8% vs. 54.5%; p = 0.102). The complication rates of the groups were low and comparable: transfusion (3.8% vs. 3.6%), fever (3.8% vs. 5.5%), hematuria (3.8% vs. 3.6%), bowel injury (0% vs. 1.8%). In mini-PCNL for multiple renal stones, non-papillary access was non-inferior to papillary access in terms of hemoglobin drop and was associated with shorter operative and fluoroscopy times, with a similar complication profile.