Comparative study between standard percutaneous nephrolithotomy and modified percutaneous nephrolithotomy: Using the shah sheath with suction system

Abstract

This two-year prospective, randomized, comparative, clinical, interventional study at Al Yarmouk Teaching Hospital's Urology Department aimed to compare the efficacy, operative time, residual stone pieces, need for auxiliary procedures, and complications between standard percutaneous nephrolithotomy (PCNL) using Amplatz sheath and modified PCNL using Shah sheath in kidney stone removal. A total of 84 patients were included, with 46 undergoing conventional PCNL and 38 undergoing Shah Sheath PCNL from September 2020 to September 2022. The average ages for the standard and Shah Sheath groups were 44.2±13.1 and 42.2±13.2 years, respectively. Stone sizes were 29.0±4.4 mm in the standard group and 30.3±4.9 mm in the Shah Sheath group. Single stones were more common than multiple stones, with a ratio of 79.8% to 20.3%. The standard group experienced higher rates of fever, sepsis, and urine leak (15.2%, 4.3%, and 4.3%, respectively), but these differences were not statistically significant (P-Value > 0.05). The conventional technique left residual fragments in 15.2% of patients, compared to only 2.6% in the Shah Sheath group (P-Value = 0.047). Shah Sheath PCNL demonstrated a reduced operational time (OR = 0.93, P-Value < 0.001) and an 85% reduction in remaining fragments (OR = 0.15, P-Value = 0.033). Additionally, the Shah Sheath method decreased the need for auxiliary procedures by 88% compared to standard PCNL, although this difference was not statistically significant (P-value = 0.12). In conclusion, Shah Sheath PCNL is a safe and effective treatment for renal stones, offering a higher stone-free rate, shorter operating time, and lower post-surgical systemic reactivity than traditional PCNL. This modified technique may provide improved outcomes for patients undergoing kidney stone removal.