Retrograde ureteral catheterization in percutaneous nephrolithotomy may be omitted in selected patients: a randomized controlled trial.

To evaluate the feasibility, safety, and efficacy of percutaneous nephrolithotomy (PCNL) performed without retrograde catheterization in the split-leg prone position in selected patients, a single-center, randomized controlled trial was carried out. 140 consecutive patients with renal stones > 2.0 cm were randomly assigned to either no ureteral catheterization split-leg prone position (NUC-SLP) group or the traditional position (TP) group, and underwent PCNL. The primary outcome was first access time. Secondary outcomes included operative time, anesthesia time, stone free rate (SFR), complications, and costs. It was noted in the RCT that, median first access time was comparable between the NUC-SLP and TP groups (10.5 [9.2, 12.5] min vs. 10.5 [8.5, 11.89] min; mean difference (MD) 0.66 min, 95% confidence interval (CI) -0.29 to 1.6; p > 0.05). The NUC-SLP group had shorter anesthesia time (77.07 ± 14.47 vs. 95.83 ± 12.22 min; MD -18.76 min, 95% CI -23.24 to -14.29; p < 0.001) and lower costs (22,053.76 ± 2,473.46 vs. 23,499.81 ± 3,863.34 Chinese Yuan (CNY), MD -1446.05 CNY, 95% CI -2531.86 to -360.23; p = 0.009). No significant difference was observed in the immediate or 1-month SFR, operative time or complications. In conclusion, retrograde ureteral catheterization may be omitted in selected patients undergoing PCNL, which simplifies the procedure, and reduces medical costs. Nevertheless, the applicability of these findings is constrained by the highly selective nature of the patient cohort (non-complex cases) and the substantial expertise of the senior endourologists, who are specifically adept at ultrasound-guided renal access and split-leg prone PCNL. Further multicenter studies involving surgeons with different levels of experience are required to validate these findings and define the optimal selection criteria.ClinicalTrials.gov: NCT06750913; April 8, 2026.