Pneumatic Versus Holmium:YAG Laser Lithotripsy During True Tubeless Mini-Percutaneous Nephrolithotomy: A Retrospective Comparative Study

Purpose: The purpose of this study is to compare stone-free and safety outcomes between pneumatic and Holmium:YAG laser lithotripsy in patients undergoing true tubeless mini-percutaneous nephrolithotomy (mini-PCNL) for renal calculi. Materials and methods: A retrospective comparative study was conducted including 34 consecutive adult patients who underwent true tubeless mini-PCNL between 2021 and 2024 at a tertiary referral center. Procedures were performed using a standardized 16-Fr tract with an 11/12-Fr operating sheath. Stone fragmentation was achieved using either pneumatic lithotripsy (Swiss LithoClast®) or a 100-W Holmium:YAG laser with a 200-µm fiber. The lithotripsy modality was selected according to surgeon preference, equipment availability, and intraoperative considerations. Stone-free status was defined as the absence of residual fragments or residual fragments <3 mm on non-contrast computed tomography performed at least 30 days after surgery. The primary outcome was the CT-confirmed stone-free rate. Secondary outcomes included estimated blood loss, postoperative sepsis, and 30-day complications. Results: Thirty-four patients were included, with 17 patients in each group. Baseline characteristics were comparable. Endoscopic stone-free rates were achieved in 15 (88.2%) and 14 (82.4%) patients in the pneumatic and Holmium:YAG laser groups, respectively (p=0.628). CT-confirmed stone-free rates were achieved in 12 (70.6%) and nine (52.9%) patients, respectively (p=0.290). Estimated blood loss and postoperative complications were comparable between groups. One patient (5.9%) in the Holmium:YAG laser group developed a Clavien-Dindo grade IV postoperative hemorrhagic complication requiring blood transfusion. Postoperative sepsis occurred in 0 (0.0%) patients. Conclusions: In this homogeneous cohort of patients undergoing true tubeless mini-PCNL, Holmium:YAG laser lithotripsy did not demonstrate superior stone-free or safety outcomes compared with pneumatic lithotripsy. Both modalities achieved comparable clinical outcomes and represent effective treatment options for appropriately selected patients.