Invasive Percutaneous Nephrolithotomy Research Articles

Experimental study of a new technique for minimally invasive percutaneous nephrolithotomy: intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy

BackgroundTo test the reliability and safety of a newly invented technique for minimally invasive percutaneous nephrolithotomy, intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy (IPC-MPCNL).MethodsEighteen kidneys of nine female pigs were randomly divided into three groups. Those in Groups A and B underwent IPC-MPCNL through the new system composed of a pressure-measuring MPCNL suctioning sheath and an irrigation and suctioning platform with pressure feedback control. The infusion flow rate was 500 ml/min in Group A and 750 ml/min in Group B. Those in Group C underwent MPCNL at an infusion flow rate of 500 ml/min. The renal pelvic pressure (RPP) monitored by a ureteral catheter and that monitored by the pressure-measuring sheath in Groups A and B were compared. The RPP in Group C was monitored by a ureteral catheter.ResultsThe RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group A was − 5.59 ± 1.95 mmHg and 4.46 ± 2.08 mmHg, respectively. The RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group B was − 4.00 ± 2.01 mmHg and 5.92 ± 2.05 mmHg, respectively. Hence, the RPPs measured by the pressure-measuring sheath in Groups A and B were consistent with those measured by the ureteral catheter. The RPP in Group C was 27.75 ± 5.98 mmHg (large fluctuations).ConclusionsIPC-MPCNL can be used to accurately monitor the RPP and maintain it within a preset safe range via suction. The new technique and the new system are safe and reliable.

A novel double-sheath negative-pressure versus conventional minimally invasive percutaneous nephrolithotomy for large kidney stone

This study aims to evaluate the therapeutic efficacy of a novel double-sheath negative-pressure minimally invasive percutaneous nephrolithotomy (D-mPCNL) compared to conventional minimally invasive percutaneous nephrolithotomy (C-mPCNL) for large kidney stones. A total of 132 patients diagnosed with large kidney stones in our hospital were included in the study. Among them, sixty-eight patients underwent D-mPCNL, while sixty-four underwent C-mPCNL. Parameters such as operative duration, stone-free rate, incidence of postoperative complications, and the need for auxiliary procedures were evaluated between the two groups. Compared to the C-mPCNL group, the D-mPCNL group demonstrated a significantly shorter operative time (41.97 ± 8.24 min vs. 52.30 ± 13.72 min; P < 0.000), lower rates of auxiliary procedures (5.9% vs. 17.2%; P = 0.041), and lower fever rates (2.9% vs. 14.1%; P = 0.021). The group also had a significantly higher primary stone-free rate (85.3% vs. 70.3%; P = 0.038). However, there were no statistically significant advantages in terms of the final stone-free rate, hemoglobin drops, and stone composition in the D-mPCNL group (P > 0.05). D-mPCNL is a novel surgical method that is safe and effective, reducing operative time, improving stone-free efficiency, and decreasing postoperative complications.

COMPLICATIONS OF MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTOMY IN THE TREATMENT OF KIDNEY STONES AT MILITARY HOSPITAL 103

Objectives: To evaluate the complications of the minimally invasive percutaneous nephrolithotomy (mini-PCNL) in treating kidney stones at Military Hospital 103. Methods: A prospective, longitudinal study on 286 kidney stone patients operated using the mini-PCNL technique at Military Hospital 103 from July 2017 to July 2019. Results: After mini-PCNL, most patients had no complication (77.62%). Bleeding and fever after mini-PCNL were the two most common complications; there were 35 patients with intraoperative bleeding and no need for blood transfusion (12.24%) and 15 patients with fever after surgery and no chills (5.24%). The stone size affected its clearance rate but did not affect fever and bleeding after mini-PCNL. After mini-PCNL, the mean values of Red Blood Cell (RBC), Hemoglobin (HGB), and Hematocrit (HCT) decreased from 4.75 ± 0.53 T/L, 140.38 ± 15.38 g/L, and 0.42 ± 0.04 L/L to 4.25 ± 0.44 T/L, 125.05 ± 13.36 g/L, and 0.38 ± 0.04 L/L, respectively. Conclusion: After mini-PCNL, the complication rate was 22.38%. Bleeding and fever after mini-PCNL were the two most common complications, with 46 patients (16.08%) and 18 patients (6.29%), respectively. The residual stone fragments were 19.58%. The stone size affected its clearance rate but did not affect fever and bleeding after mini-PCNL

Efficacy and safety of minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of upper urinary tract stones (> 1 cm): a systematic review and meta-analysis of 18 randomized controlled trials

BackgroundThe advantages and disadvantages of retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (mPCNL) for treatment of upper urinary tract calculi have not been conclusively determined.MethodsIn this meta-analysis, We comprehensively evaluated the performance of the two surgical approaches in treatment of upper urinary calculi. We searched the Pubmed, Embase, Cochrane and Web of science databases for randomized controlled trial (RCT) articles on RIRS and mPCNL upto December 2022. Data were extracted by two independent reviewers and subjected to the meta-analysis using the Stata 15.1 software (StataSE, USA).ResultsA total of 18 eligible RCTs involving 1733 patients were included in this study. The meta-analysis revealed that mPCNL of 1–2 cm or 2–3 cm stones had a higher stone clearance rate (RR:1.08, 95%CI (1.03, 1.14), p = 0.002) and shorter operation time (WMD : -10.85 min, 95%CI (-16.76, -4.94), p<0.001). However, it was associated with more hospital stay time (WMD :1.01 day, 95%CI(0.53, 1.5), p<0.001), hemoglobin drops (WMD :0.27 g/dl, 95%CI (0.14, 0.41), p<0.001), blood transfusion rate (RR:5.04, 95%CI(1.62, 15.65), p = 0.005), pain visual analogue score (WMD:0.75, 95%CI (0.04, 1.46), p = 0.037), hospital costs (SMD :-0.97, 95%CI (-1.19, -0.76), p<0.001) and major complications (RR:1.89, 95%CI(1.01, 3.53), p = 0.045).ConclusionTherefore, in terms of surgical effects and operation time, mPCNL is superior to RIRS, but is inferior with regards to other perioperative parameters. These factors should be fully considered in clinical decision making.

The Vortex Effect in Minimally Invasive Percutaneous Nephrolithotomy

The Vortex Effect in Minimally Invasive Percutaneous Nephrolithotomy

Retracted: Application of Clavien-Dindo Classification System for Complications of Minimally Invasive Percutaneous Nephrolithotomy.

[This retracts the article DOI: 10.1155/2021/5361415.].

The Vortex Effect in Minimally Invasive Percutaneous Nephrolithotomy

To describe the physical principles of the vortex effect to better understand its applicability in minimally invasive percutaneous nephrolithotomy (MIP) procedures. Two acrylic phantom models were built based on the cross-sectional area (CSA) ratio of a MIP nephroscope and access sheaths (15/16F and 21/22F MIP-M™, Karl Storz®). The nephroscope phantom was 10mm in diameter. The access sheaths had diameters of 14mm (CSA ratio: 0.69) and 20mm (CSA ratio: 0.30). The models were adapted to generate hydrolysis, and hydrogen bubbles enhanced flow visualization on a green laser background. After calibration, the experimental flow rate was set to 12.0mL/s. Three 30-second trials assessing the flow were performed with each model. Computational fluid dynamic simulations were completed to determine the speed and pressure profiles. In both models, as the incoming fluid from the nephroscope phantom attempted to move toward the collecting system, a stagnation point (SP) was demonstrated. No fluid entered the collecting system phantom. Utilizing the 14mm-sheath, we observed a random generation of several vortices and a pressure gradient (PG) of 114.4N/m2 between the nephroscope's tip and SP. In contrast, examining the 20mm-sheath revealed a significantly smaller PG (19.4N/m2) and no noticeable vortices were noted. The speed of the fluid and equipment geometry regulate the PG and the vortices field, which are responsible for the production of the vortex effect. Considering the same flow rate, a higher ratio between the CSA of the nephroscope and access sheath results in improved efficacy of the vortex effect.

Comparative efficacy between retrograde intrarenal surgery with vacuum-assisted ureteral access sheath and minimally invasive percutaneous nephrolithotomy for 1-2 cm infectious upper ureteral stones: a prospective, randomized controlled study.

To observe the efficacy and safety of retrograde intrarenal surgery combined with vacuum-assisted ureteral access sheath (V-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 1-2 cm infectious upper ureteral stone. A total of 173 patients with 1-2 cm infectious upper ureteral stone were prospectively randomized into two groups. Eighty-six in the V-UAS group and 87 cases as control in the MPCNL group. The SFRs at different times (Postoperative 1 day, 2nd week and 4th week) was considered as the primary outcome of the study. The secondary end points were operative time, postoperative hospital stay and operative complications. There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that the SFR at postoperative 1 day in the V-UAS group was significantly lower than that in the MPCNL group (73.2% vs. 86.2%, P = 0.034). However, there was no statistical significance between two groups in SFRs during postoperative 2 weeks and 4 weeks (All P > 0.05). The levels of WBC, CRP and PCT were all significant lower in the V-UAS group than those in the MPCNL group at the postoperative 24 h and 48 h (all P < 0.05). Postoperative complications included fever (≥38.5°C), bleeding, pain and urosepsis. In terms of the rates of fever, pain and urosepsis, MPCNL group were all significantly higher than those in the V-UAS group (10.3 vs. 2.4%, P = 0.031; 14.9 vs. 2.4%, P = 0.003; 4.6 vs. 0.0%, P = 0.044; respectively). No significant difference was found between two groups in bleeding. Meanwhile, postoperative hospital stay in the V-UAS group was more shorten than that in the MPCNL group (3.7 vs. 5.9 days, P < 0.001). Our study showed that RIRS with V-UAS, a new partnership to treat 1-2 cm infectious upper ureteral stones, was satisfying as it achieved a high SFR rate and a low rate of infectious complications. This method was safe and reproducible in clinical practice.

Comparing the Effectivity of Intravenous Analgetic Tramadol and Intravenous Paracetamol for Acute Post-Percutaneous Nephrolithotomy

There are many management strategies and interventions both preoperative, intraoperative, and postoperative that can be carried out in dealing with postoperative pain. Guidelines for pain management have been prepared by the American Pain Society (APS) with recommendations from the American Society of Anesthesiologists (ASA) where there are many recommendations in postoperative pain management in adults or children by promoting the provision of preoperative education, the use of various modalities both pharmacological and non-pharmacological to the establishment of pain management procedures or policies in each institution. For this reason, the author was interested in examining the comparison of the effectiveness of analgesia between intravenous tramadol and intravenous Paracetamol in minimally invasive Percutaneous Nephrolithotomy (PCNL) postoperative patients at RSUP Dr. M. Djamil Padang. The research was a prospective study with a single-blind randomised controlled trial design. The data used were sourced from clinical trials conducted on post-PCNL patients divided into two subgroups given intravenous tramadol analgetics and others given Paracetamol tablets. In this study, the incidence of Nephrolithiasis was obtained, which was dominated by the male sex, compared to women and suffered a lot at the age of 41-60 years. There was a significant difference in VAS effectiveness between the use of Paracetamol IV and Tramadol IV in post-PCNL patients. The use of Paracetamol may be considered to replace tramadol in the disappearance of acute pain after PCNL postoperative patients in those patients who are allergic to tramadol.

Vacuum-assisted access sheet in minimally invasive percutaneous nephrolithotomy in the supine position

Vacuum-assisted access sheet in minimally invasive percutaneous nephrolithotomy in the supine position

Safety and efficacy of minimally invasive percutaneous nephrolithotomy for infantile nephrolithiasis. Single centre experience from Pakistan.

To assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1-2 cm in size in infants less than one year. This descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications. A total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5-12 month). The mean stone size was 15.8 + 2.7 (10-21) mm in length and 12.3 + 2.2 (8-17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40-70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9-2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients. Mini-PCNL is a safe and effective treatment for renal stones in infants measuring 1-2 cm with high SFR and an acceptable complication rate.

Effects of severe hydronephrosis on surgical outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL).

The impact of severe hydronephrosis on the outcomes of minimally invasive percutaneous nephrolithotomy (MPCNL) remains controversial; it is still a subject well worth exploration. To investigate the effects of severe hydronephrosis on surgical outcomes of MPCNL, especially on operative time (OT) and stone-free rate (SFR). In total, 301 patients who underwent MPCNL were included in this study and divided into 4 groups according to the degree of hydronephrosis (nil, mild, moderate, and severe hydronephrosis, respectively). Univariate analyses and multivariate logistic analyses were used to determine the risk factors affecting OT and SFR. Patients with severe hydronephrosis had a longer OT (p < 0.001), a decreased SFR (p < 0.001), and a higher postoperative haemoglobin drop and blood transfusion rate compared to the other 3 cohorts (p = 0.011 and p = 0.043, respectively). Univariate analyses determined that severe hydronephrosis, calyx for access, stone location, stone type, stone size, and number of tracts significantly correlated with OT, while severe hydronephrosis, stone location, stone type, and stone size showed a strong association with SFR (all p < 0.05). Multivariate analyses further identified that severe hydronephrosis (OR = 3.496, p = 0.013), stone location (≥ 4 calyces: OR = 3.024, p = 0.017), stone type (staghorn: OR = 5.204, p = 0.002), and stone size (≥ 1600 mm2: OR = 12.669, p < 0.001; 800-1599 mm2: OR = 5.194, p < 0.001) were significant risk factors affecting OT, while SFR was independently influenced by stone type (staghorn: OR = 4.377, p = 0.039; multiple: OR = 3.778, p = 0.044), stone location (≥ 4 calyces: OR = 4.413, p = 0.020; 2-3 calyces: OR = 3.617, p = 0.034), and severe hydronephrosis (OR = 7.093, p = 0.001). Severe hydronephrosis is a significant risk factor that can lead to longer OT and lower SFR, and correlates with increased risk of bleeding and blood transfusion rate in some cases during MPCNL. Accordingly, severe hydronephrosis is an influential factor that should not be ignored when performing MPCNL.

Effect of Flexible Ureteroscopic Lithotripsy on Surgical Outcomes, Renal Function and Quality of Life of Patients with 2-3 cm Renal Calculi.

This retrospective study aims to analyse the effect of flexible ureteroscopic lithotripsy (FURSL) on the surgical outcome, renal function (RF) and quality of life (QoL) of patients with 2-3 cm renal calculi. A total of 111 patients with renal calculi (2-3 cm) admitted from January 2019 to May 2022 were selected. Among them, 55 patients who underwent minimally invasive percutaneous nephrolithotomy (PCNL) were set as the control group and 56 patients treated with FURSL served as the research group. The control group consisted of 29 males and 26 females aged (43.31 ± 6.49) years on average. The research group consisted of 31 males and 25 females, with a mean age of (42.46 ± 7.44) years. Parameters such as surgical outcomes (stone clearance rate, bleeding volume, operation time and postoperative recovery time), incidence of adverse reactions (ARs: Gross hematuria, fever, urinary tract infection (UTI) and urinary tract injury), RF (blood urea nitrogen (BUN) and serum creatinine (Scr)), pain degree and QoL were compared. No significant difference in the stone clearance rate was found between the groups. Compared with the control group, the research group had statistically longer operation time, less bleeding, postoperative recovery time, and incidence of ARs and pain and obviously higher QoL. BUN and Scr differed insignificantly between the groups before and after surgery. FURSL can accelerate postoperative recovery in patients with 2-3 cm renal calculi, lower the risk of postoperative ARs, mitigate pain and improve QoL without significantly affecting RF.

Tubeless versus conventional minimally invasive percutaneous Nephrolithotomy: A comparative study

PCNL (Percutaneous Nephrolithotomy) and MPCNL (Miniaturized Percutaneous Nephrolithotomy) are minimally invasive surgical procedures used to treat kidney stones. Both PCNL and MPCNL are effective treatments for kidney stones, but the choice of procedure depends on the size, location, and number of stones, as well as the patient&#39;s medical history and overall health. The present study was aimed to assess the safety and efficacy of tubeless PCNL compared to conventional PCNL in terms of Postoperative pain, hospital stay, Drop in Haemoglobin levels, Operative time, Stone free rate, Post operative fever. Methodology: A Prospective comparative interventional study has been done in Department of Urology, Mamata Super Specialty Hospital, Khammam with a total of 50 patients who were randomized into two groups of 25 each undergoing tubeless mini PCNL and conventional mPCNL respectively. Results: The mean age was 43.76 years and 41.92 years for mini PCNL and conventional mPCNL groups respectively, the mean calculus size in the tubeless PCNL group was 2.028 cm, while in the conventional PCNL group, it was 2.452 cm. There was significantly lesser operative time taken in conventional PCNL group when compared with Tubeless PCNL group. Stone free clearance rate 97% in tubeless PCNL. The mean hospital stay in tubeless PCNL group was significantly more than that in conventional PCNL. Conclusion: Both tubeless mPCNL and conventional mPCNL had similar surgical outcomes, but tubeless mPCNL had reduced surgery time, stone clearance, and hospital stay, indicating its potential for wider use.

Contemporary Management of Large and Complex Renal Calculi: Have we found the Perfect Solution Yet?

Abstract This review provides a thorough overview of contemporary treatment strategies for complex renal calculi, including large-volume stones, stones with increased hardness and greater number, or stones with abnormal anatomy. The development of tailored treatment plans for stone removal is essential for treatment success. A literature search was conducted on PubMed using the Keyword “complex renal calculi” along with “percutaneous nephrolithotomy (PCNL),” “retrograde intrarenal surgery (RIRS),” “endoscopic combined intrarenal surgery (ECIRS),” “stone free rate,” and “complications.” Based on the findings, the use of “minimally invasive PCNL,” “multiple-tract PCNL,” “staged RIRS,” and “ECIRS” is proposed in addition to the traditional PCNL suggested using the European Association of Urology guidelines. Renal calculi in patients with solitary kidneys or who underwent kidney transplants are considered to be complex, and treatment options that allow preservation of their remaining renal function should be considered.

RIRS AND MINI-PCNL IN MANAGEMENT OF KIDNEY STONE: A COMPARATIVE STUDY

To compare results of retrograde intrarenal surgery and minimally invasive percutaneous nephrolithotomy in older patients, a retrospective study was conducted at the Department of Nephrology &amp; Urology of MMDC&amp;Ibn-e-Sina Hospital Multan from January 2021 to January 2022. The study included 135 patients, 65 underwent M-PCNL while 70 underwent RIRS. Gender, age, BMI, ASA scores, stone location and size, ESWL history, SFR and relevant parameters were recorded. Characteristics like gender, age, BMI, stone size and location, HU and ESWL history did not vary significantly in both group (p&gt;0.05). Mean ASA scores and the data of ASA I and ASA II in both groups was also similar (p&gt;0.05). Postoperative Clavien complications, operation time and postoperative transfusion rate in both groups did not vary significantly (p&gt;0.05). M-PCNL patients had greater post operative SFR values (p&lt;0.05). Retrograde intrarenal surgery and minimally invasive percutaneous nephrolithotomy arerecommended methodsin treatment of kidney stones.

Comparison of minimally invasive percutaneous nephrolithotomy and ureteroscopy in the management of impacted proximal ureteral stones

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter and other factors which impede stone access, visibility and lithotripsy and can lead to different types of complications. The objective of our study is to compare the efficacy and safety of minimally invasive percutaneous nephrolithotripsy (mini-PCNL) and ureteroscopy (URS) in the treatment of impacted proximal ureteral stones. Material and methods: The medical records of 345 patients with impacted proximal ureteral stones 10-20 mm, treated between January 2016 – November 2022 were retrospectively reviewed. 178 patients (51.6%) underwent mini-PCNL, and 167 (48.4%) – URS. Data on patients’ preoperative characteristics, stone-free rates, operating times, intra- and postoperative complications were compared. Results: Patients’ preoperative characteristics were comparable between the two groups, except for mean stone surface and stone size, which were significantly higher in the mini-PCNL group (respectively, 137.87±44.32mm2 vs 80.94±29.66mm2, p=0.000; and 15.03±2.43 vs 12.02±2.22mm, p=0.000). The stone free rate after single procedure was 94.9% for mini-PCNL and 89,3% in the URS group (p=0,116). Four patients (2.3%) in the mini-PCNL group had significant hemorrhage necessitating selective renovasography and angioembolization of AV fistula. 21 (12.5%) patients had stones showing upward migration during the URS procedure and 3 (1.8%) had partial perforation of the ureteral wall. Hemoglobin drop was significantly higher in mini-PNL group (13.58±12.79g/l vs 4.69±5.72g/l, p=0,000). Mean operative time was significantly longer in the URS group, despite the smaller size of the stones (respectively, 41.41±13.62min vs. 30.67±10.34min, p=0,000). There were statistically significant difference of the necessity of auxiliary procedures in the URS group (respectively, 78 patients (46,4%) vs 6 patients (3.6%), p=0.000). Conclusions: For an impacted, proximal ureteral stone mini-PNL had better stone-free rates, shorter operative time and low percentage of auxiliary procedure and hospitalizations. However, URS had the advantages of less invasiveness procedure and shorter postoperative hospital stay.

Minimally Invasive Percutaneous Nephrolithotomy Combined with Holmium: YAG Laser for Treatment of Large Renal Stones

Minimally Invasive Percutaneous Nephrolithotomy Combined with Holmium: YAG Laser for Treatment of Large Renal Stones

Comparison of Tubeless Percutaneous Nephrolithotomy and Ordinary Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Renal Calculi

Comparison of Tubeless Percutaneous Nephrolithotomy and Ordinary Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Renal Calculi

A prospective, single-centered, cohort study comparing the treatment of renal stones by following PCNL types: Standard, tubeless & totally tubeless

IntroductionRenal stones are a frequent cause of morbidity globally. The number of lumbotomies performed for benign lithiasis has been greatly decreased with the usage of Percutaneous Nephrolithotomy (PCNL). Further development is aimed at reducing tract size, leading to numerous advanced minimally invasive PCNL procedures like mini-PERC, ultra-mini-PERC, and micro-PERC. The aim of this study was to evaluate whether tubeless or totally tubeless PCNL is the safest and most efficient, less morbid management technique for renal stones compared to the standard PCNL with a nephrostomy tube. MethodologyThis is a comparative, prospective, single-centered, cohort study that took place between August 2015 and January 2018 in the Urology department of Benazir Bhutto Hospital in Rawalpindi, Pakistan. 218 patients having single/multiple stones of variable sizes were enrolled in the study. Participants were stratified into three groups; Group A: Standard PCNL treatment; Group B: Tubeless PCNL treatment; Group C Totally Tubeless treatment. Mean operation time (±SD) and stone-free rates were our primary outcomes. The rate of complications during and post-operative complications were our secondary outcomes. ResultsA total of 181 patients were included in our study. A decreasing trend can be seen in mean operation time as we move from Group A to Group C (p = 0.000). The rate of problems during operation in each group was highest (45.8%) in Group A, much lesser problems in Group C (13.3%), and least problems in Group B (8.1%) (p = 0.000). The postoperative complication rate was again the highest in Group A (30.5%), low in Group C (8.3%), and extremely low in Group B (1.6%) ConclusionTubeless PCNL proved to be the safest and most effective when compared to standard and totally tubeless PCNL procedures. It also showed the highest stone-free rates and least ‘unsatisfactory’ results amongst all the groups. Conclusively, it should be performed in routine preferably.