Clinical outcomes of needle-perc-assisted endoscopic surgery for 2–4 cm renal calculi: a propensity score-matched comparative study with subgroup analysis by stone infection status
- 1Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China
Abstract
Purpose: To compare needle-perc-assisted PCNL (NS) and needle-perc-assisted RIRS (NR) with Standard PCNL for 2–4 cm renal calculi and explore effect modification by infectious-stone status.
Patients and methods: This retrospective cohort included 365 patients treated between January 2021 and September 2025. Two independent 1:1 propensity score-matched comparisons were constructed. The primary outcome was the 1-month stone-free rate (SFR), defined as no residual fragment ≥4 mm on KUB radiography. Matched outcomes were analyzed using paired methods, with Holm adjustment for the two principal SFR comparisons.
Results: Matching yielded 48 Standard PCNL–NS pairs and 86 Standard PCNL–NR pairs. SFR was 85.4% with NS vs. 72.9% with Standard PCNL (RD, 12.5%; 95% CI, −3.6% to 28.6%; exact McNemar P = 0.210; Holm-adjusted P = 0.210) and 91.9% with NR vs. 80.2% with Standard PCNL (RD, 11.6%; conditional exact 95% CI, −0.1% to 20.1%; exact McNemar P = 0.052; Holm-adjusted P = 0.104). Exploratory analyses associated NS with less fever and a smaller postoperative WBC increase but greater analgesic use. NR was associated with less analgesic use, longer operative time, and shorter hospitalization. Treatment-by-infectious-stone-status interactions were not statistically significant for NS or NR (P = 0.647 and P = 0.942).
Conclusion: SFR estimates numerically favored NS and NR, but superiority over Standard PCNL was not established. These exploratory findings support further prospective evaluation of Needle-perc-assisted surgery in selected patients.
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BibTeX
@article{wang2026clinical,
title = {{Clinical outcomes of needle-perc-assisted endoscopic surgery for 2–4 cm renal calculi: a propensity score-matched comparative study with subgroup analysis by stone infection status}},
author = {Yuxian Wang and Peizhi Zhang and Zheng Xu and Daxun Luo and Yuzhe Tang and Jianxing Li},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1938484},
url = {https://doi.org/10.3389/fmed.2026.1938484},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical outcomes of needle-perc-assisted endoscopic surgery for 2–4 cm renal calculi: a propensity score-matched comparative study with subgroup analysis by stone infection status
AU - Yuxian Wang
AU - Peizhi Zhang
AU - Zheng Xu
AU - Daxun Luo
AU - Yuzhe Tang
AU - Jianxing Li
PY - 2026
DA - 2026/10/22
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1938484
UR - https://doi.org/10.3389/fmed.2026.1938484
AB - Purpose: To compare needle-perc-assisted PCNL (NS) and needle-perc-assisted RIRS (NR) with Standard PCNL for 2–4 cm renal calculi and explore effect modification by infectious-stone status. Patients and methods: This retrospective cohort included 365 patients treated between January 2021 and September 2025. Two independent 1:1 propensity score-matched comparisons were constructed. The primary outcome was the 1-month stone-free rate (SFR), defined as no residual fragment ≥4 mm on KUB radiography. Matched outcomes were analyzed using paired methods, with Holm adjustment for the two principal SFR comparisons. Results: Matching yielded 48 Standard PCNL–NS pairs and 86 Standard PCNL–NR pairs. SFR was 85.4% with NS vs. 72.9% with Standard PCNL (RD, 12.5%; 95% CI, −3.6% to 28.6%; exact McNemar P = 0.210; Holm-adjusted P = 0.210) and 91.9% with NR vs. 80.2% with Standard PCNL (RD, 11.6%; conditional exact 95% CI, −0.1% to 20.1%; exact McNemar P = 0.052; Holm-adjusted P = 0.104). Exploratory analyses associated NS with less fever and a smaller postoperative WBC increase but greater analgesic use. NR was associated with less analgesic use, longer operative time, and shorter hospitalization. Treatment-by-infectious-stone-status interactions were not statistically significant for NS or NR (P = 0.647 and P = 0.942). Conclusion: SFR estimates numerically favored NS and NR, but superiority over Standard PCNL was not established. These exploratory findings support further prospective evaluation of Needle-perc-assisted surgery in selected patients.
SN - 2296-858X
ER -