Clinical curative effect of B-ultrasound-guided minimally invasive percutaneous nephrolithotomy and its influences on stone clearance rate in patients with complex kidney stones

This study compares short-term perioperative and early postoperative outcomes of B-ultrasound-guided minimally invasive percutaneous nephrolithotomy (MPCNL) and retroperitoneal laparoscopic pyelolithotomy (RLP) in patients with complex kidney stones. This single-center retrospective observational cohort included 120 eligible patients treated between December 2020 and December 2023. Patients were classified according to the treatment actually received (RLP, n = 60; B-ultrasound-guided MPCNL, n = 60); no random allocation was performed. Outcomes included perioperative indicators, 24-hour visual analog scale pain score, 48-hour inflammatory and renal biomarkers, early ultrasound-defined stone clearance at postoperative day 1, and in-hospital complications. Operation time, intraoperative blood loss, and length of hospital stay were lower in the MPCNL group than in the RLP group (nominal P < .05). Early ultrasound-defined stone clearance was 91.67% (55/60) versus 78.33% (47/60), corresponding to a risk difference of 13.3 percentage points (95% confidence interval [CI] = 0.2–25.6), a risk ratio of 1.17 (95% CI = 1.00–1.36), and a Pearson chi-square P = .041. This comparison did not meet a conservative Bonferroni-adjusted threshold of 0.0042 for 12 reported endpoints. At 24 hours, visual analog scale scores were lower in the MPCNL group, and at 48 hours, inflammatory and renal biomarkers were lower (nominal P < .05). Complications occurred in 2/60 (3.33%) versus 8/60 (13.33%); because of sparse events, Fisher exact test was used ( P = .095; risk ratio = 0.25, 95% CI = 0.06–1.13). B-ultrasound-guided MPCNL was associated with more favorable short-term perioperative and biomarker outcomes and a nominally higher early ultrasound-defined clearance rate than RLP. However, the retrospective nonrandomized design, incomplete baseline adjustment, short follow-up, outcome-measurement limitations, and multiple comparisons preclude causal or long-term effectiveness claims. These findings should be considered hypothesis-generating and require confirmation in adequately powered prospective comparative studies.