{
    "abstract": "This study aims to evaluate the impact of through-and-through (T-T) guidewire positioning versus conventional guidewire positioning in percutaneous nephrolithotomy (PCNL) with endoscopic combined intrarenal surgery (ECIRS) on complication rates (CR), surgical outcomes, and predictors of post-operative complications. We analyzed data from patients who underwent PCNL in our institution. Patients were divided into the T-T group (guidewire positioned through the urethral meatus) and the No-T-T group (guidewire positioned within the renal pelvis or down the ureter). Pre-, peri-, and post-operative data were collected, including demographics, clinical characteristics, stone parameters, and surgical outcomes. Statistical analyses, including t-tests, chi-square tests, and logistic regression, were performed to compare outcomes and identify complication predictors. The T-T group exhibited a lower overall CR (28.57% vs. 53.68%, p\u2009<\u20090.05), a higher stone-free rate (SFR) (78.09% vs. 62.1%, p\u2009=\u20090.02), and resulted in reduced blood loss (\u2206Hb 1.30\u00a0g/dL vs. 1.73\u00a0g/dL, p\u2009<\u20090.05), radiation exposure time (RET) (383.1 vs. 469.1\u00a0s, p\u2009<\u20090.05), and hospital stay (HS) (3.97 vs. 4.8\u00a0days, p\u2009<\u20090.05). The T-T technique was a protective factor against complications (OR\u2009=\u20090.26, p\u2009<\u20090.05). In patients with high stone complexity, the T-T technique was associated with lower CR (34.78% vs. 61.5%, p\u2009=\u20090.03) and higher SFR (71.74% vs. 51.28%, p\u2009=\u20090.04). Higher BMI, positive urine culture, and hydronephrosis were predictors of increased complication risk. The T-T guidewire technique is associated with lower CR, higher SFR, reduced blood loss, and shorter HS. These findings suggest that the T-T technique may enhance surgical outcomes and should be considered a valuable approach in managing large renal calculi. Further studies are recommended to confirm these results.",
    "authors": [
        {
            "affiliation": "UOC Urologia, E.O. Ospedali Galliera, Genoa, Italy.",
            "firstname": "Federico",
            "initials": "F",
            "lastname": "Dotta"
        },
        {
            "affiliation": "Facolt\u00e0 Di Farmacia E Medicina, UOC Urologia, Sapienza Universit\u00e0 Di Roma, ICOT, Polo Pontino, Latina, Italy. manfredibruno.sequi@uniroma1.it.",
            "firstname": "Manfredi Bruno",
            "initials": "MB",
            "lastname": "Sequi"
        },
        {
            "affiliation": "Facolt\u00e0 Di Farmacia E Medicina, UOC Urologia, Sapienza Universit\u00e0 Di Roma, ICOT, Polo Pontino, Latina, Italy.",
            "firstname": "Damiano",
            "initials": "D",
            "lastname": "Graziani"
        },
        {
            "affiliation": "UOC Urologia, E.O. Ospedali Galliera, Genoa, Italy.",
            "firstname": "Mattia",
            "initials": "M",
            "lastname": "Tosi"
        },
        {
            "affiliation": "UOC Urologia, E.O. Ospedali Galliera, Genoa, Italy.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Benelli"
        },
        {
            "affiliation": "Facolt\u00e0 Di Farmacia E Medicina, UOC Urologia, Sapienza Universit\u00e0 Di Roma, ICOT, Polo Pontino, Latina, Italy.",
            "firstname": "Antonio",
            "initials": "A",
            "lastname": "Carbone"
        },
        {
            "affiliation": "UOC Urologia, E.O. Ospedali Galliera, Genoa, Italy.",
            "firstname": "Carlo",
            "initials": "C",
            "lastname": "Introini"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",
    "doi": "10.1007/s00240-025-01742-z\n10.1002/bco2.219\n10.1590/s1677-5538.Ibju.2015.0007\n10.1007/s11255-010-9801-0\n10.4111/icu.20200276\n10.1016/j.eururo.2008.07.073\n10.3390/jcm13020621\n10.1007/s00345-017-2001-0\n10.1111/bju.13703\n10.1016/j.urology.2012.10.004\n10.1007/s00345-016-1929-9\n10.3892/etm.2020.8486\n10.1016/j.urology.2010.12.026\n10.5301/ru.2012.9521\n10.5152/tud.2020.20282\n10.1016/j.urolvj.2022.100188\n10.1177/0391560320962404\n10.1111/j.1464-410X.2007.06960.x\n10.22037/uj.v14i6.4080\n10.1016/j.urology.2009.08.087\n10.1111/bju.12104\n10.1007/s11255-004-0744-1\n10.1089/vid.2016.0046\n10.4081/aiua.2021.2.162\n10.1089/end.2015.0278\n10.1097/mou.0000000000000232",
    "journal": "Urolithiasis",
    "keywords": [
        "Complication rates",
        "Percutaneous nephrolithotomy",
        "Stone-free rate",
        "Surgical outcomes",
        "Through-and-through guidewire"
    ],
    "methods": null,
    "publication_date": "2025-04-12",
    "pubmed_id": "40220075\n37636203\n26689529\n20628815\n33660446\n18715696\n39597932\n28124111\n27862806\n23374772\n27614706\n32256747\n21333334\n23371265\n32877638\n33028166\n17552975\n29101757\n20022089\n23924426\n15783093\n32292638\n34286549\n26414226\n26555687",
    "results": null,
    "title": "The impact of antegrade guidewire positioning outside the external urethral meatus in supine PCNL: the through and through technique.",
    "xml": "<Element 'PubmedArticle' at 0x7885052b0ae0>"
}