Urinary tract infection (UTI) is a common and serious complication after percutaneous nephrolithotomy (PCNL).This study develops and validates the PuRass scoring system to predict the risk of UTI, including urinary sepsis, after PCNL and support personalized clinical Management. A retrospective analysis of 293 PCNL patients was conducted, incorporating multiple risk factors, including gender, age, diabetes, preoperative white blood cell count, urine analysis and culture results, stone size and type, and the degree of hydronephrosis. Significant risk factors were identified through meta-analysis and integrated into PuRass, with each factor weighted according to its odds ratio (OR) value to establish a quantitative risk assessment model. Results showed that gender, age, diabetes, elevated white blood cell count, and positive urine analysis and culture results significantly increased the risk of post-PCNL UTI. The PuRass model demonstrated excellent predictive performance in ROC curve analysis, achieving 90% sensitivity and 89.4% specificity, with an optimal threshold of 8.5 points. Early intervention strategies based on PuRass effectively reduced infection rates and hospital stays in high-risk patients. This study indicates that PuRass provides a reliable tool for predicting and managing post-PCNL UTI. Future multicenter studies will further validate its clinical applicability and explore its integration with emerging technologies to enhance postoperative management.

To evaluate the safety and efficacy of single-session supine bilateral percutaneous nephrolithotomy (BPCNL) in patients with bilateral renal stones. We retrospectively identified patients from February 2019 to July 2023 with bilateral renal stones measuring >2 cm and <5 cm in their maximum dimension for each side mainly located in the renal pelvis that had been treated with single-session supine BPCNL. The stone-free rate was accepted when remaining fragments of ⩽ 2 mm were discovered by a computed tomography scan. Fifty-two patients with bilateral renal stones measuring 2:5 cm in their maximum dimension for each side who had been treated with single-session supine BPCNL were included in the study; a statistically significant difference in serum creatinine level was detected on day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.403 and 0.471 respectively). Also, statistically significant difference in glomerular filtration rate was detected at day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.95 and 0.07 respectively implicating early renal affection that shortly returned to normal values. The mean operative time for both sides was 126.5 ± 22.9 min, and the mean hemoglobin drop after the procedure was 1.9 ± 0.99 g/dl. The primary stone-free rate was 75%, with 11.6% of the remaining patients had a residual insignificant stones >2 mm but still less than 6 mm. Finally, 13.4% of the patients needed ancillary procedures. Single-session supine bilateral PCNL is both safe and effective for patients with bilateral renal stones. However, this is a complex procedure that should only be performed by expert surgeons in a tertiary centers. (167) SPS/URS_008 retrospectively registered.

Comparison of flexible ureteroscopy combined with negative pressure suction sheath and percutaneous nephrolithotomy for treating staghorn calculi: a single-centre study.

Introduction Extracorporeal Shockwave Lithotripsy (SWL) remains a pivotal, non-invasive treatment modality for urolithiasis, having revolutionized the management of stone disease since its introduction in the 1980s (Preminger et al., 2024; Long &amp; Matlaga, 2020). Despite its established role, the current clinical landscape sees SWL increasingly challenged by highly effective, though more invasive, endourological techniques such as Ureteroscopic Lithotripsy (URSL/RIRS) and Percutaneous Nephrolithotomy (PCNL). The enduring relevance of SWL hinges critically upon optimal patient selection and rigorous adherence to technical optimization protocols to maximize efficacy and minimize failure rates (Wang et al., 2020). Methods A systematic search compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed, synthesizing outcomes from high-level evidence studies, including meta-analyses encompassing a minimum of 15 randomized controlled trials (RCTs) (Li et al., 2023; Mokhtari et al., 2023). Data were extracted for 12 clinical outcomes. The quality of comparative trials was assessed using the Cochrane Risk of Bias tool, version 2 (RoB 2) (Higgins et al., 2024; Minozzi et al., 2022). Results Efficacy and Logistics: Contemporary endourological treatments generally yield higher efficacy; URSL/PCNL result in significantly superior overall stone-free rates (SFRs) compared to SWL, especially for stones exceeding 10 mm and those located in the lower pole calyx (Wang et al., 2015). SWL is associated with a significantly greater need for retreatment procedures, with an Odds Ratio (OR) of 0.08 favoring URSL (Li et al., 2023). However, SWL maintains substantial logistical advantages, including a significantly shorter operating time (Standardized Mean Difference -29.314 minutes favoring SWL) and shorter hospital stay (Mean Difference 1.14 days longer for URSL) (Mohamed et al., 2023; Li et al., 2023). Safety and Predictors: While overall complication rates are statistically similar across methods (Li et al., 2023), URSL carries a higher specific risk of perforation (OR 0.13 favoring SWL) (Mohamed et al., 2023). Successful SWL is highly predictable based on pre-treatment imaging, with optimal success linked to stone density HU &lt; 1000 and SSD &lt; 10 cm (Siddiqui &amp; Ahmed, 2021; Türk et al., 2024; Ouzaid et al., 2014). Furthermore, technical refinement, such as decreasing the shock wave rate to 60 to 90 shocks per minute, substantially improves stone fragmentation efficacy (Long &amp; Matlaga, 2020). Long-Term Safety: A significant association exists between SWL performed for nephrolithiasis and the development of new-onset hypertension, evidenced by an overall Relative Risk (RR) of 1.21 (95% CI 1.11–1.31) (Seo et al., 2021). This risk increases with the number of SWL sessions required (Rudnick et al., 2018). Conclusion Extracorporeal Shockwave Lithotripsy remains the optimal non-invasive intervention for highly favorable calculi (≤ 10 mm, low HU, short SSD), provided technical optimization is rigorously applied. For stones predicted to be resistant, early treatment pivot toward URSL or PCNL is warranted to maximize definitive stone clearance and to mitigate the potentially dose-dependent long-term risk of hypertension and the requirement for multiple auxiliary procedures.

ObjectivesTo prospectively capture patient‐reported outcomes in the post‐operative period to better understand the quality‐of‐life impact of percutaneous nephrolithotomy (PNL).Subjects and MethodsAdults undergoing PNL for renal/ureteral stones were eligible for inclusion (11/2020–8/2022). Patients prospectively completed PROMIS – Pain Intensity, Pain Interference and Ability to participate in social roles and activities in‐person pre‐operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T‐scores (normalized to US pop., mean = 50) with a change of 5 (0.5 SD) considered clinically significant.ResultsA total of 62 participants enrolled at POD 0 (POD 1 = 28, POD 7 = 29, POD 14 = 20, POD 30 = 23). There was a worsening of quality of life from POD 0 to POD 1 for pain intensity (median difference 7.9, p = 0.005) and pain interference (median difference 11.9, p = 0.0003), but not for the ability to participate in social roles (median difference −5.3, p = 0.07). This was also observed for POD 0 to POD 7, but only for the dimension of pain interference (median difference 7.2, p = 0.02). All three dimensions then improved until POD 30. In multivariable analysis, there were no variables associated with severe symptomatology for any of the three dimensions.ConclusionsPain intensity and interference sharply increase immediately post‐operatively, reducing quality of life, although the ability to participate in social roles is not impacted. The absolute magnitude of this change is significant, with a final improvement at 30 days at or above baseline. Results offer meaningful insight to assist in setting expectations for patients post‐operatively.

Primary hyperparathyroidism (PHPT) patients who undergo parathyroidectomy (PTX) have significantly reduced rates of kidney stone events based on imaging and patient-reported history. However, there has been limited knowledge on the impact of PTX on stone disease requiring surgical intervention. The aim of this study was to compare the incidence of kidney stone surgery before and after PTX. PHPT patients who underwent PTX from 2015-2023 at our institution were retrospectively reviewed. We evaluated the incidence of kidney stone treatment by shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) based on CPT codes. Univariate and multivariate analyses were performed to compare the incidence rate before and after PTX. We included 1554 patients who underwent PTX and identified 101 kidney stone surgeries. Patients were 75% female, 16% non-white race and had a median age of 63years (IQR 55-71) at the time of PTX. The median follow-up time was 5.2years before and 3.3years after PTX. The incidence of kidney stone surgery in patients pre- vs post-PTX was 80 events/7668 person-years (1.0%) vs 21 events/5318 person-years (0.4%) respectively, (p < 0.0001). Thus, the incidence rate of requiring stone surgery decreased by 2.64 times following PTX (95% CI 1.62-4.50, p < 0.0001). The cases of URS and SWL decreased whereas the cases of PCNL increased (p < 0.02). The incidence of stone disease requiring surgical intervention significantly decreased following PTX. It remains critical to screen recurrent stone formers for PHPT, as surgical correction with PTX may help reduce subsequent stone surgeries and associated comorbidities.

Percutaneous nephrolithotomy (PCNL) is traditionally performed in the prone position, though this may pose anesthetic risks for high-risk patients. The flank position has been proposed as an alternative, but evidence remains limited. This systematic review of seven studies (2008–2023) found that flank PCNL achieves stone-free rates of 85–91%, comparable to prone positioning, with similar complication profiles and indications of reduced bleeding and respiratory issues. Operative time varied across studies, while hospital stay remained consistent. Overall, the findings support flank PCNL as a safe and effective alternative, though small sample sizes and methodological heterogeneity highlight the need for larger multicenter research.

To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with a flexible vacuum-assisted ureteral access sheath (FV–UAS) in patients with large renal stones (LRS). A total of 149 patients with LRS were prospectively randomized into two groups: 75 in the FV–UAS group and 74 in the minimally invasive percutaneous nephrolithotomy (MPCNL) group. The primary outcome was the stone-free rates (SFRs) on the first postoperative day. Secondary endpoints included the total SFRs 1 month postoperatively, lithotripsy time, hemoglobin reduction, length of postoperative hospital stay, quality of life (QoL) score improvement, incidence of ureteral stricture at 3 months postoperatively, and any surgery-related complications. Patient demographics and preoperative clinical characteristics showed no apparent difference between the two groups (all P > 0.05). Postoperative data revealed a significantly longer lithotripsy time in the FV–UAS group than the MPCNL group (113.1 vs. 82.5 min, P < 0.001). The mean decrease in hemoglobin was significantly lower in the FV–UAS group than in the MPCNL group (8.2 vs. 17.7 g/L, P < 0.001). Similarly, the average hospital stay was shorter in the FV–UAS group than the MPCNL group (1.7 vs. 5.1 d, P < 0.001). Meanwhile, SFRs on the first postoperative day and 1 month postoperatively were statistically similar between the two groups (P > 0.05). QoL improvement was significantly higher in the FV–UAS group than in the MPCNL group (33.4 vs. 26.9, P < 0.001). The difference in ureteral stricture at 3 months postoperatively was not statistically significant (P > 0.05). Notably, the overall rate of postoperative complications was markedly lower in the FV–UAS group than in the MPCNL group (P < 0.05). Our study showed the safety and feasibility of applying RIRS combined with FV–UAS for LRS treatment, providing advantages such as high SFRs, minimal trauma, fast recovery, and low incidence of postoperative complications. It can be used as a clinical treatment alternative for LRS. The protocol for this study has been accepted by the Chinese Clinical Trial Registry (Ethics approval number: ChiCTR2200056402; Date of registration: 02-05-2022).

Purpose: To investigate the safety and feasibility of non-papillary puncture in total ultrasound (US)-guided standard size access percutaneous nephrolithotomy (PCNL) for patients with complex renal stones. Patients and Methods: We retrospectively reviewed the charts of complex renal stones (Guy's scoring system 3-4) patients who had undergone standard size access PCNL in our department from January 2019 to October 2023 (n = 422). Renal abnormalities, history of PCNL and pyelolithotomy/nephrolithotomy, and multiple tracts PCNL were excluded. Two hundred A total of 218 eligible patients were finally enrolled. These patients were allocated to two groups according to puncture site: papillary (Group 1, n = 182) and non-papillary (Group 2, n = 36). All procedures were guided by total US. Single standard access (22-24 F) was achieved in all patients. Relevant patient characteristics, operative variables, and postoperative data were collected and analyzed, with a focus on the stone-free rate (SFR) and bleeding complications. Results: Successful percutaneous renal puncture was achieved in all patients. Patients' basic characteristics (gender, age, body mass index, stone size, surgical side) were similar between the two groups. The SFRs in the papillary puncture group were significantly higher than the non-papillary puncture group (81.3% vs 69.4%, p = 0.03). Hemoglobin loss in Group 2 is much more significant than in Group 1 (18.4 ± 5.4 g/L vs 10.4 ± 4.7 g/L, p = 0.02). Overall non-severe complication (Clavien-Dindo Grade 1-2) rates were significantly lower in Group 1 (p = 0.02, 0.03). The operative duration, transfusion rate, severe complication rate, and renal function changes show no significant difference between the two groups. Conclusion: US-guided PCNL through a standard-access tract is necessary for renal papilla puncture. Non-papillary puncture increases bleeding volume and reduces SFR, and should be avoided in complex stones whenever possible.

Outcome of Push-Back and Percutaneous Nephrolithotomy in Comparison to Laparoscopic Ureterolithotomy for the Treatment of Upper Ureteric Stone

Introduction: Given the high incidence and recurrence of nephrolithiasis, technological advances have been made to dramatically improve minimally invasive techniques for treatment of kidney stone, such as extracorporeal shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL). SWL is the standard method in the treatment of kidney stones smaller than 10 mm while PCNL methods of choice in the treatment of kidney stones larger than 20 mm. But for the choice of method for the treatment of 10 to 20 mm, upper and middle calices stones still there are conflicting opinions. Objectives: The aim of the study was to evaluate the efficacy and safety of SWL and PCNL in the treatment of 10-20 mm kidney stonei in the middle and upper pole and to choose the optimal procedure. Material and methods: The clinical study was designed as a randomized prospective study and conducted in GH "8th of September" - Skopje in the period from December 2023 to Januar 2025. During the study for both methods were analysed success rate, rate of re-treatment, the need for additional procedures, the degree of complications and the duration of the intervention and the hospital stay. Results: The study included 81 patients randomized into two groups. The first group included 41 patients treated with SWL, and the second group included 40 patients treated with PCNL. SWL vs. PCNL success rate was 90% vs. 82.9% (p = 0.29); the rate of re-treatment of SWL was 39.02% versus 0% of PCNL. (p = 0.00001). The additional procedures were equally present in the two treatment groups 14.64% in SWL and 15% in PCNL (p = 0.96). PCNL was associated with a significantly longer duration of treatment versus SWL, 110.2 ± 17.7 minutes versus 47.1 ± 3.3 minutes respectively (p = 0.00000). Complications were less frequently detected in patients treated with SWL compared to patients treated with PCNL, 17.1% versus 32.5% respectively. (p = 0.11) The mean length of hospital stay was significantly shorter in patients treated with SWL compared to PCNL, 1.1 ± 0.4 versus 6.0 ± 1.7 days (p &lt;0.0001). Conclusion: This study shows that PCNL and up to three SWL treatments are safe and comparatively effective in treating patients with stones in the upper and middle calices ranging 10–20 mm.

Renal stones, with a global prevalence of 10%, pose significant challenges, particularly when 2–3 centimeters in size, because of limitations of treatments like percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (F-URS) provides a minimally invasive alternative. To investigate the result of retrograde flexible URS in the management of renal stones (2–3 centimeters) at Ibn Sina Teaching Hospital, Sirte, Libya. This was prospective observational research carried out at Ibn Sina Teaching Hospital in Sirte, Libya. A total of ninety-seven consecutive cases with renal stones of 2-3 centimeters were enrolled in the research. All cases provided informed consent before the procedure, and the research was permitted by the institutional ethics committee. The mean age of cases was 48.7 ± 11.3 years (63.9% male). The mean size of the stone was 2.3 ± 0.3 centimeters, predominantly in the renal pelvis (42.3%). SFR was 68.04% after one session, 88.6% after two, and 94.8% after three. Mean operative time was 102.01 ± 34.69 minutes, and hospitalization was 2.5 ± 1.3 days. Complications included mild hematuria (12.4%), fever (8.2%) (Clavien Grade I), urinary tract infections (6.2%, Grade II), and sepsis (4.1%, Grade IV). RIRS is an effective, safe choice for 2–3 cm kidney stones, offering higher SFR and reduced complication rates than PCNL

Effects of Percutaneous Nephrolithotomy on Renal Morphology and Arterial Vascular Resistance

To assess the safety and efficacy of combined ultrasonography (US) and fluoroscopy-guided percutaneous nephrolithotomy (CG-PCNL) vs pure US-guided endoscopic combined intrarenal surgery (USG-ECIRS) for treating 4-6-cm renal calculi. This prospective randomised trial was conducted in the period May 2022 to April 2025 at the Second Affiliated Hospital of Anhui Medical University and Zhongda Hospital of Southeast University. A total of 114 consecutive patients with 4-6-cm renal calculi were randomly assigned to undergo CG-PCNL or USG-ECIRS, with 57 patients per group. The primary outcomes of the study were the first stone-free rate (SFR) and tract establishment success rate, with secondary outcomes including operating time, haemoglobin drop and complication rate. The study was registered at http://www.chictr.org.cn (ChiCTR2200057865). A total of 106 patients were included in the analysis, with 53 in each group. The two groups had similar baseline characteristics. There was no significant difference in first SFR between the groups (81.1% vs 79.2%; P = 0.872). In patients with S.T.O.N.E. scores >10 or stones involving more than five calyces, SFR was markedly lower in both groups. No intergroup differences were detected in either tract establishment time or initial success rate. The operating time in the CG-PCNL group was significantly longer than that in the USG-ECIRS group (143.2 vs 93.6 min; P < 0.001). Haemoglobin drop was significantly more pronounced in the CG-PCNL group compared to the USG-ECIRS group (14.9 vs 10.3 g/L; P = 0.043). The overall incidence of complications in the CG-PCNL group was significantly higher than that in the USG-ECIRS group (18.9% vs 5.7%; P = 0.038). Use of USG-ECIRS showed comparable efficacy to use of CG-PCNL in the management of 4-6-cm renal calculi, while demonstrating superior safety with fewer complications and less blood loss. However, the SFR declined for both approaches when the S.T.O.N.E. score exceeded 10 or when stones involved more than five calyces.

PurposeSuper-mini percutaneous nephrolithotomy (SMP) is a promising minimally invasive approach for upper tract stone management. However, evidence on its performance using suction sheath and pneumatic lithotripsy in resource-limited setting remains scarce. The main objective of this study is to examine the efficacy and safety of SMP done exclusively with this combination.MethodsProspectively collected data of all eligible SMP cases done in two centers between March 2021 and February 2025 were retrospectively processed. After de-identification of the final data, descriptive and analytical statistics were used as appropriate. Regression models were then constructed to identify risk factors for complications.ResultsTotal of 324 prone SMP procedures were performed on 319 patients. The mean stone volume, operating time and fluoroscopy beam-on time were 1473 mm3, 38 min, and 145 s respectively. The mean hemoglobin drop was 1.2 ± 0.9 gm% with 2.1% of patients requiring blood transfusion. Overall, stone-free rate was 96.9% at 1-month follow-up, minor complications (Clavien-Dindo ≤ II) being 13.4%, and major complications (Clavien-Dindo > II) being 2.2%. Multinomial regression analysis revealed operating time > 40 min, positive urine culture, and access through 10th intercostal space as significant predictors of complications. Limitation includes retrospective design, lack of computerized tomography for confirming stone-free status, and lack of intra-renal pressure monitoring.ConclusionSMP using a combination of suction sheath and pneumatic lithotripsy is a safe and effective treatment option for selected cases with upper tract lithiasis in resource-limited settings, with high stone clearance and acceptable complication rates.

Introduction: Ureteroscopy (URS) is the most commonly performed surgery for the management of renal stones. Post-URS sepsis has been reported to be around 5%, but most studies rely on purchased datasets or electronic medical record (EMR) data that pull data based on billing codes of sepsis without clinical verifications. This study aims to evaluate the true incidence of sepsis using the Sepsis-3 criteria at a single tertiary care institution. Methods: A retrospective review was conducted on all URS procedures at a single tertiary care institution from 2021 to 2022, including both Medicare and private insurance patients ≥18 years old. The EMR was queried for URS procedure codes and readmission within 30 days post-procedure with a sepsis diagnosis code. All other procedures, including URS during percutaneous nephrolithotomy, were excluded. Each identified case was evaluated for sepsis using the Sepsis-3 criteria, including sequential organ failure assessment (SOFA) and quick SOFA (qSOFA). Results: A total of 1316 patients underwent URS. Nineteen patients were identified with a sepsis diagnosis, giving an initial post-URS sepsis rate of 1.44%. After EMR verification, 5 patients were excluded, leaving 14 (1.06%) patients with a diagnosis code of sepsis. Using Sepsis-3 criteria, only 6 (0.44%) met the diagnosis. Conclusions: This retrospective review identified only 0.44% of patients with a true post-URS sepsis within 30 days using Sepsis-3 criteria. The difference in our rate from the initial query and current literature highlights the need for accurate clinical diagnosis and documentation of sepsis.

Objective: To evaluate the effectiveness, onset time, duration, and quality of both sensory and motor block, along with hemodynamic stability and postoperative pain relief, between 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine during subarachnoid block in patients undergoing percutaneous nephrolithotomy (PCNL) procedures. Methods: This prospective, randomized, observer-blinded study compared the efficacy of 0.75% hyperbaric ropivacaine and 0.5% hyperbaric levobupivacaine for subarachnoid block in 150 patients undergoing percutaneous nephrolithotomy (PCNL) surgeries. Patients were randomly allocated into two groups: Group R (n=75) received 4 ml of 0.75% hyperbaric ropivacaine, and Group l (n=75) received 4 ml of 0.5% hyperbaric levobupivacaine intrathecally. The onset and duration of the sensory and motor blockade, analgesia, perioperative hemodynamic variations, side effects, and complications were evaluated. Results: Group l showed significantly earlier onset times for sensory (7.96±1.13 min vs. 9.99±2.57 min; P&lt;0.0001) and motor blocks (2±0.62 min vs. 2.74±0.9 min; P&lt;0.0001) compared to Group R. The duration of sensory block (83.33±10.18 min vs. 59.57±8.15 min), analgesia (145.49±7.93 min vs. 127.8±6.22 min), and motor block (287.25±40.72 min vs. 199±24.38 min) were significantly longer in Group l (P&lt;0.0001). The hemodynamic parameters remained stable in both groups, with no significant differences between the groups. The incidence of side effects was comparable between the groups. Conclusion: In conclusion, 0.5% hyperbaric levobupivacaine provides a faster onset and prolonged duration of sensory and motor blockade, as well as extended analgesia, compared to 0.75% hyperbaric ropivacaine for subarachnoid block in PCNL surgeries, with a similar safety profile.

This study investigates the safety, efficacy, and educational potential of the 5G-powered robot-assisted teleultrasound diagnostic system (RTDS) for guiding percutaneous nephrolithotomy (PCNL) in a one-to-many telemedicine model, addressing medical resource disparities in remote regions. Forty-five patients with complex kidney stones (Guy's Stone Scores III-IV) underwent RTDS-assisted PCNL across multiple regions (Xinjiang, Chongqing, Liyang, Suqian), with a maximum distance of 5800km. Experts from the First Affiliated Hospital of Nanjing Medical University remotely operated the RTDS to assist local surgeons in establishing percutaneous renal access. Primary endpoints included one-session stone-free rate (SFR), first puncture success rate, and Clavien-Dindo complication rate. Secondary endpoints, such as operative time and hemoglobin drop, were also evaluated. Subjective assessments of surgeon workload and emotional state were conducted using the NASA Task Load Index (NASA TLX) and Medical Emotion Scale (MES). For contextual comparison, a systematic review and meta-analysis of published studies on conventional ultrasound-guided PCNL was conducted. The one-session stone-free rate (SFR) reached 80%, with a first-puncture success rate of 76.9%. No complications above grade II were observed, and the complication rate (8.9%) was lower than traditional ultrasound-guided PCNL (16%). Meta-analysis revealed RTDS had comparable SFR but superior safety and first puncture success rates. Surgeons reported reduced intraoperative workload and heightened confidence, underscoring RTDS's educational utility. The one-to-many telemedicine mode exhibited stable performance, facilitating simultaneous real-time guidance for multiple surgeries in geographically dispersed locations. The 5G-powered RTDS is a safe, effective, and innovative tool for guiding PCNL. It not only bridges healthcare disparities by providing high-quality medical services in remote regions but also enhances the training of junior surgeons, promoting the equitable development of advanced surgical techniques. This study primarily reports original prospective clinical data. The supplementary meta-analysis serves only as contextual reference and should not be interpreted as a substitute for randomized controlled trials.

To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy (T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm. This retrospective analysis included 270 patients with renal calculi with a maximum diameter of 2-3 cm treated between January 2022 and July 2024. Of these, 146 cases were treated with single-use ureteroscopic lithotripsy through an FV-UAS, while 124 cases were treated by tubeless PCNL (T-PCNL group) through a 16F Amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFRs) were compared. There was no significant difference in the stone-free rates (SFRs) between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI), 0.56-2.28; odds ratio (OR) = 1.13; P = .724. The SFRs at 1 month postoperatively were: 95% CI, 0.417-2.60; OR = 1.041; P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were: 95% CI, 0.355-1.055; OR = 0.612; P = .076; the SFRs at 1 month postoperatively were: 95% CI, 0.374-1.320; OR = 0.703; P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P = .813 and P = .839, respectively). The surgical duration in the FV-UAS group was significantly longer (P < .001). The decrease in postoperative hemoglobin (Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (both P < .001). For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.

To evaluate the safety profile and efficacy of novel suction devices compared to current practices in the management of renal and upper ureteric stones in the adult population, as negative pressure suction devices during retrograde intrarenal surgery (RIRS) are designed to overcome commonly encountered issues including poor visibility, residual fragments, and elevated intrarenal pressures (IRPs). A systematic search of the literature was conducted on 21 December 2024 using Embase, Medline and Scopus. Only English papers involving adult populations with typical anatomy were accepted. A total of 35 articles were deemed suitable for the purposes of this review. Various methods of suction-assisted RIRS have been described, including suction ureteric access sheaths, tip-flexible suction ureteric access sheaths, direct in-scope suction and aspiration catheters, as a means to improve the safety and efficacy of RIRS. Suction devices have shown significant advantages by vacuuming debris to improve visibility and maximise stone clearance, even for larger stones typically managed by percutaneous nephrolithotomy. Improved stone-free rates, shorter operating times, less requirement for basketing and fewer auxiliary surgeries have subsequently been observed. Use of intelligent pressure monitoring has the added benefit of maintaining low IRP intraoperatively, which reduces infectious complications like fever and sepsis. These techniques may offer substantial health economic benefits by reducing operating time, intraoperative costs, and hospital stays. However, the lack of high-level evidence limits the standardisation of this technology, currently. Suction technology in RIRS optimises stone clearance and reduces complication rates by improving visibility, evacuating debris and also maintaining low IRP. With further research, it promises to be a useful adjunct to current practices.