Single site multi puncture supine (SMS) PCNL procedure in patient with complex renal stone: One incision, why should more?

Introduction: Since percutaneous nephrolithotomy (PCNL) was introduced in 1976, it has been the standard procedure for large renal stones. Over time, the PCNL technique changed and developed into various techniques. We introduce single site multipuncture supine (SMS) PCNL to give cosmetic advantage due to less tissue injury in complex renal stone. This study aimed to determine the outcome SMS PCNL procedure in patients with complex renal stones diseases. Materials and methods: This study was a retrospective study including all patients with kidney stones who had undergone SMS PCNL at the Urology Department of Saiful Anwar General Hospital from March 2019 until December 2022. All SMS PCNL procedures were performed by a single operator. The patients were divided into three groups that included that were treated with 2, 3, and 4 punctures. The data were collected using SPSS ver. 25. Result: Ninety-three patients were included in this study. The characteristics of the patient such as gender, age, BMI were not significantly different among the groups. The outcome of SMS PCNL procedure showed low complication rate during operation in 2-,3-,and 4-puncture groups (3.2%, 7.4%, 0%, respectively). The Stone Free Rate (SFR) showed no significant difference between the 3 groups (p = 0.496). The SFR was 85.7% in 2-puncture, 77.8% in 3-puncture, 66.7% in 4-puncture group. The AUC of Guy's Stone Score with cut off value was 3.5 (AUC = 0.549, p-value = 0.541, CI 95%). Conclusions: Single Site Multi Puncture PCNL is safe and efficient approach to complex renal stones. Single Site Multipunctures Supine PCNL is comparable with other techniques of PCNL and gives minimal tissue injury that would benefit for cosmetic.