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Abstract <p>To assess if adjunct flexible Nephroscopy, Inspection, and Calyceal Examination (NICE) improves stone-free rate (SFR) after suction mini-percutaneous nephrolithotomy (SM-PCNL).&#xa0;This prospective multicenter study included 1534 SM-PCNL patients (March-November 2024) from 30 centers across 21 countries. Post intervention, patients underwent calyceal inspection via fluoroscopy alone (Group 1, <i>n</i> = 1022) or fluoroscopy plus NICE (performed via antegrade flexible nephroscopy or retrograde ureteroscopy) (Group 2, <i>n</i> = 512) to check for per operative injury and stone clearance. Stone-free status (SFS) was assessed by 30-day non-contrast CT (NCCT): Grade A (zero residual fragments, ZRF), B (single ≤4&#xa0;mm), or C (&gt; 4&#xa0;mm/multiple).&#xa0;Group 2 had larger stones (diameter: 22&#xa0;mm vs. 19&#xa0;mm, volume: 2100&#xa0;mm³ vs. 1498&#xa0;mm³, <i>p</i> &lt; 0.001), higher Guy’s stone scores (Grade 2–4: 54.5% vs. 43.9%, <i>p</i> &lt; 0.001), and longer operative times (55 vs. 42&#xa0;min, <i>p</i> &lt; 0.001). Notably, Group 2 exhibited significantly lower ZRF (75.6% vs. 86.6%), higher Grade B (18.9% vs. 11.9%) and Grade C fragments (7.0% vs. 3.7%, <i>p</i> &lt; 0.001). Multivariate analysis revealed the odds of ZRF did not improve with NICE (OR 0.69, 95%CI 0.50–0.95; <i>p</i> = 0.024) and increased 30-day reinterventions (4.5% vs. 1.5%; <i>p</i> &lt; 0.001). Complications were comparable (10.5% vs. 11.3%, <i>p</i> = 0.677). Intraoperative SFS assessment correlated better with NCCT in Group 1 (81.2% vs. 76.0%; <i>p</i> = 0.017), with superior accuracy in identifying ZRF (90.4% vs. 84.1%; <i>p</i> = 0.001).&#xa0;In SM-PCNL, the use of NICE in complex cases was not associated with improved ZRF or overall SFR (Grade A + B) compared to fluoroscopy alone, despite its preferential use in more challenging scenarios. Fluoroscopy alone showed better intraoperative-NCCT correlation for residual fragments and shorter operative times. Based on these findings, routine use of NICE in SM-PCNL is not supported. Its selective application may be considered in complex cases where direct visualisation is deemed crucial.</p>

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Can flexible nephroscopy, inspection, and calyceal examination (NICE) post suction mini percutaneous nephrolithotomy improve zero and overall stone free rate? an EAU endourology and AUSET collaboration study

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Kanghua Xiao,
  • Vineet Gauhar,
  • Daniele Castellani,
  • Jaisukh Kalathia,
  • Nariman Gadzhiev,
  • Vigen Malkhasyan,
  • Nitesh Kumar,
  • Mehmet Ilker Gokce,
  • Gopal Ramdas Tak,
  • Edgar Beltrán‑Suárez,
  • Khi Yung Fong,
  • Andreas Skolarikos,
  • Esteban Acuña,
  • Marek Zawadzki,
  • Wissam Kamal,
  • Leonardo Gomes Lopes,
  • Ali Talyshinskii,
  • Arman Tsaturyan,
  • Amelia Pietropaolo,
  • Wei Zhu,
  • Guohua Zeng,
  • Bhaskar K. Somani,
  • Thomas R. W. Herrmann,
  • Steffi Kar Kei Yuen

摘要

Abstract

To assess if adjunct flexible Nephroscopy, Inspection, and Calyceal Examination (NICE) improves stone-free rate (SFR) after suction mini-percutaneous nephrolithotomy (SM-PCNL). This prospective multicenter study included 1534 SM-PCNL patients (March-November 2024) from 30 centers across 21 countries. Post intervention, patients underwent calyceal inspection via fluoroscopy alone (Group 1, n = 1022) or fluoroscopy plus NICE (performed via antegrade flexible nephroscopy or retrograde ureteroscopy) (Group 2, n = 512) to check for per operative injury and stone clearance. Stone-free status (SFS) was assessed by 30-day non-contrast CT (NCCT): Grade A (zero residual fragments, ZRF), B (single ≤4 mm), or C (> 4 mm/multiple). Group 2 had larger stones (diameter: 22 mm vs. 19 mm, volume: 2100 mm³ vs. 1498 mm³, p < 0.001), higher Guy’s stone scores (Grade 2–4: 54.5% vs. 43.9%, p < 0.001), and longer operative times (55 vs. 42 min, p < 0.001). Notably, Group 2 exhibited significantly lower ZRF (75.6% vs. 86.6%), higher Grade B (18.9% vs. 11.9%) and Grade C fragments (7.0% vs. 3.7%, p < 0.001). Multivariate analysis revealed the odds of ZRF did not improve with NICE (OR 0.69, 95%CI 0.50–0.95; p = 0.024) and increased 30-day reinterventions (4.5% vs. 1.5%; p < 0.001). Complications were comparable (10.5% vs. 11.3%, p = 0.677). Intraoperative SFS assessment correlated better with NCCT in Group 1 (81.2% vs. 76.0%; p = 0.017), with superior accuracy in identifying ZRF (90.4% vs. 84.1%; p = 0.001). In SM-PCNL, the use of NICE in complex cases was not associated with improved ZRF or overall SFR (Grade A + B) compared to fluoroscopy alone, despite its preferential use in more challenging scenarios. Fluoroscopy alone showed better intraoperative-NCCT correlation for residual fragments and shorter operative times. Based on these findings, routine use of NICE in SM-PCNL is not supported. Its selective application may be considered in complex cases where direct visualisation is deemed crucial.