{
    "abstract": "Urolithiasis is a common urological condition, and percutaneous nephrolithotomy (PCNL) is a widely used treatment option for renal stones. The trifecta analysis, which includes the complete stone-free rate (SFR), absence of complications (Clavien-Dindo classification), and no need for auxiliary procedures, provides a standardized method for comparing outcomes. This study evaluates the trifecta outcomes of standard PCNL versus mini PCNL Methodology: This prospective cohort study was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar, from January 2022 to March 2024. A total of 180 consecutive patients who underwent PCNL\u00a0were enrolled in the study. Using a lottery method, patients were randomly assigned to two equal groups (standard PCNL and mini PCNL). Both groups consisted of 90 patients each. Patients who required a change in the planned surgical procedure were replaced with new participants from the sample frame. A structured proforma was used to record preoperative, perioperative, and postoperative data for the\u00a0trifecta analysis. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, NY, United States). Logistic regression was performed to assess predictive factors for the trifecta, and the odds ratio (OR), confidence interval (CI), and p-value were calculated.\nThe mean age in the standard PCNL group was 43.21 \u00b1 3.51 years vs 44.03 \u00b1 3.17 years in the mini PCNL group (p = 0.10). The mean stone size in the standard PCNL group was 30.62 \u00b1 5.88 mm vs 30.28 \u00b1 6.03 mm in the mini PCNL group (p = 0.70). The mean stone density in the standard PCNL group was 1366.25 \u00b1 74.28 HU vs 1342.66 \u00b1 107.34 HU in the mini PCNL group (p = 0.08). Stones were completely cleared in 84 (93.3%) patients in the standard PCNL group and 69 (76.7%) in the mini PCNL group (p = 0.02). Auxiliary procedures, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and repeat double J (DJ) stenting, were required in four patients (4.4%) in the standard PCNL group compared to 20 patients (20%) in the mini PCNL group. Regarding complications, the standard PCNL group recorded complications in 16 patients (17.77%), including Grade 1 (six patients), Grade 2 (five patients), and Grade 3 (five patients), according to the Clavein-Dindo classification. In the mini PCNL group, six patients (6.66%) experienced postoperative complications, including Grade 1 (five patients) and Grade 2 (one patient) (p = 0.02). The overall trifecta success rate was 71.12% in the\u00a0standard PCNL group vs 50.03% in the mini PCNL group.\nThe trifecta analysis indicates that standard PCNL has a higher SFR, while mini PCNL is safer but requires more auxiliary procedures.",
    "authors": [
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Immad",
            "initials": "I",
            "lastname": "Ahmed"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Liaqat",
            "initials": "L",
            "lastname": "Ali"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Abdul",
            "initials": "A",
            "lastname": "Haseeb"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Khizer",
            "initials": "K",
            "lastname": "Zaman"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Nauman Ul",
            "initials": "NU",
            "lastname": "Mulk"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Fayyaz",
            "initials": "F",
            "lastname": "Ullah"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.\nDepartment of Urology, Leicester General Hospital, University Hospitals of Leicester (UHL) NHS Trust, Leicester, GBR.",
            "firstname": "Muhammad",
            "initials": "M",
            "lastname": "Raheel"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Muhammad",
            "initials": "M",
            "lastname": "Zohaib"
        },
        {
            "affiliation": "Department of Urology, Hayatabad Medical Complex, Peshawar, PAK.",
            "firstname": "Jamal A",
            "initials": "JA",
            "lastname": "Shah"
        }
    ],
    "conclusions": "The trifecta analysis indicates that standard PCNL has a higher SFR, while mini PCNL is safer but requires more auxiliary procedures.",
    "copyrights": "Copyright \u00a9 2025, Ahmed et al.",
    "doi": "10.7759/cureus.80328",
    "journal": "Cureus",
    "keywords": [
        "endoscopic stone surgery",
        "endourology",
        "percutaneous nephrolithotomy (pcnl)",
        "trifecta",
        "urolithiasis"
    ],
    "methods": null,
    "publication_date": "2025-04-10",
    "pubmed_id": "40206887\n33574911\n26344917\n27238616\n38978895\n9870281\n35953608\n29549382\n27017353\n36431265\n34786926\n20811557\n12675858\n35773639\n33554728\n37208652\n27010782\n33769014\n34104489",
    "results": "The mean age in the standard PCNL group was 43.21 \u00b1 3.51 years vs 44.03 \u00b1 3.17 years in the mini PCNL group (p = 0.10). The mean stone size in the standard PCNL group was 30.62 \u00b1 5.88 mm vs 30.28 \u00b1 6.03 mm in the mini PCNL group (p = 0.70). The mean stone density in the standard PCNL group was 1366.25 \u00b1 74.28 HU vs 1342.66 \u00b1 107.34 HU in the mini PCNL group (p = 0.08). Stones were completely cleared in 84 (93.3%) patients in the standard PCNL group and 69 (76.7%) in the mini PCNL group (p = 0.02). Auxiliary procedures, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), and repeat double J (DJ) stenting, were required in four patients (4.4%) in the standard PCNL group compared to 20 patients (20%) in the mini PCNL group. Regarding complications, the standard PCNL group recorded complications in 16 patients (17.77%), including Grade 1 (six patients), Grade 2 (five patients), and Grade 3 (five patients), according to the Clavein-Dindo classification. In the mini PCNL group, six patients (6.66%) experienced postoperative complications, including Grade 1 (five patients) and Grade 2 (one patient) (p = 0.02). The overall trifecta success rate was 71.12% in the\u00a0standard PCNL group vs 50.03% in the mini PCNL group.",
    "title": "Comparison of Trifecta Outcomes in Standard Versus Mini Percutaneous Nephrolithotomy for Renal Stone Management.",
    "xml": "<Element 'PubmedArticle' at 0x788503e04d60>"
}