Comparing laser vs mechanical lithotripsy in suction mini‐PCNL for kidney stone disease: A prospective multicentre study by the endourology section of EAU

Objectives To compare perioperative outcomes, complications and stone‐free rates (SFRs) between laser and non‐laser lithotripsy in suction‐assisted mini‐PCNL (SM‐PCNL). Subjects and Methods This prospective multicentre study enrolled adults with normal kidneys undergoing SM‐PCNL (14–22 Fr) across 30 international centres (March–November 2024). Patients were divided into laser (Group 1) and non‐laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30‐day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications. Results After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non‐laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30‐day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single‐step dilation (OR 3.05) and sheath sizes of 16.5–18 Fr (OR 1.98) or 20–22 Fr (OR 2.72) were associated with higher odds of stone‐free status, while skin‐to‐stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non‐metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications. Conclusions Both laser and non‐laser lithotripsy are effective in SM‐PCNL. Non‐laser devices improve efficiency and lasers were preferentially used with 14–18 fr access tracts.