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To compare the safety and efficacy of mini-PCNL with vacuum-assisted access sheath in the second-stage treatment of renal calculi with obstructive pyonephrosis. A prospective, randomized clinical study was performed at our hospital from May 2020 to May 2022. Patients with pyogenic drainage fluid who needed percutaneous nephrolithotomy were randomized to the peel-away assisted mini-PCNL group (group A) and the vacuum-assisted mini-PCNL group (group B). Demographic information, clinical features, and perioperative period data were collected. Fifty mini-PCNLs using a single 16 F access sheath were performed in all patients of our study. All patients underwent second-stage surgical treatment. Demographic information and clinical features were not significantly different between groups A and B. But compared with group A, patients in group B had a short operative time (60.60 ± 7.68 min  vs.  82.20 ± 14 min  p  = 0.018), a lower post-operative fever rate (8%  vs.  32%  p  = 0.034), and a higher stone-free rate 2 d after the operation (88%  vs.  64%  p  = 0.047). There was no significant difference between the two groups in blood transfusion, HB deficit, PCT after the operation, total hospitalization costs, stone-free rate 30 d after the operation, and length of stay or stay post-operative. And no serious complications after the operation occurred in either group. Mini-PCNL with vacuum-assisted access sheath is a safe and efficient treatment for patients with calculi-related obstructive pyonephrosis in the second stage.

Mini-PCNL with a vacuum-assisted access sheath for renal calculi with pyonephrosis in the second stage