Carlo Giulioni, Vineet Gauhar, Daniele Castellani, Steffi Kar-Kei Yuen, Federico Falsetti, Angelo Cafarelli, Khi Yung Fong, Jaisukh Kalathia, Nariman Gadzhiev, Alexey G Martov, Vigen Malkhasyan, Abu Baker, Arun Chawla, Abhay Mahajan, Kazumi Taguchi, Lazaros Tzelves, Leonardo Gomes Lopes, Yiloren Tanidir, Mohamed Omar, Mahmoud Laymon, Mehmet İlker Gökce, Chin Tiong Heng, Kaushikkumar Shah, Dilip Kumar Mishra, Andreas Skolarikos, Bhaskar Somani
Both disposable and reusable sheaths yield comparable stone clearance in SM-PCNL. However, disposable sheaths are associated with fewer complications and may offer practical advantages in settings with limited reprocessing capabilities. Further randomized trials and cost-effectiveness studies are warranted to guide sheath selection in diverse clinical environments.
OBJECTIVE: To evaluate the perioperative outcomes of suction mini-percutaneous nephrolithotomy (SM-PCNL) using disposable versus reusable sheaths, based on data from the global Suction Technology Utility in Mini-Percutaneous nephrolithotomy Study (STUMPS) registry.
METHODS: This prospective, multicenter observational study analyzed adult patients undergoing SM-PCNL using either disposable or reusable suction sheaths (14-22 Fr) between March 2024 and November 2024 across 30 centers in 21 countries. Propensity score matching was employed to balance key variables, including age, sex, Guy's stone score, stone volume, and patient position. Primary outcomes included 30-day stone-free rates, complications, and operative metrics. Multivariable logistic regression was performed to identify predictors of complete (Grade A) stone clearance.
RESULTS: Among 1524 patients, 1024 were matched for analysis (512 in each group). Both groups had comparable distributions of 30-day postoperative residual fragment grades (p=0.90), with similar stone-free rates (Grade A clearance: 80% in the reusable group vs. 81% in the disposable group). The disposable group demonstrated a significantly lower 30-day complication rate (9.4% vs. 15%; p=0.01), including fewer renal pelvic injuries and bleeding events. However, operative time was longer in this group (median 50 min vs. 44 min; p=0.02), and the reintervention rate was higher (3.3% vs. 1.0%; p=0.02). Predictors of reduced stone clearance included supine positioning, smaller sheath size, and larger stone volume.
CONCLUSION: Both disposable and reusable sheaths yield comparable stone clearance in SM-PCNL. However, disposable sheaths are associated with fewer complications and may offer practical advantages in settings with limited reprocessing capabilities. Further randomized trials and cost-effectiveness studies are warranted to guide sheath selection in diverse clinical environments.