Nelaton versus Malecot Nephrostomy after Supine Mini-PCNL: A Comparative Study of Removal-Related Complications and Cost.

INTRODUCTION: Optimal nephrostomy tube selection following percutaneous nephrolithotomy (PCNL) remains controversial. Existing literature has largely emphasized overall complication rates; however, drainage-related mechanical events during catheter removal have not been adequately explored. This study aimed to compare 12 Fr Nelaton probes and re-entry Malecot nephrostomy catheters after mini-PCNL in terms of cost and early postoperative drainage-related complications. METHODS: This single-center retrospective observational study included patients who underwent mini-PCNL between January 2023 and March 2026 and received either a 12 Fr Nelaton probe or a re-entry nephrostomy catheter at the end of the procedure. The primary endpoints were total per-patient cost and early postoperative complications associated with catheter removal. Secondary endpoints included stone-free rate (SFR), hemoglobin change, transfusion requirement, operative time, length of hospital stay, and overall complications. RESULTS: A total of 230 patients were analyzed (mean age 45.8±14.7 years). Malecot catheters were used in 64.8% of cases and Nelaton probes in 35.2%. The overall complication rate was 16.5%, predominantly Clavien-Dindo Grade I-II. No significant differences were observed between the groups regarding overall complications, residual stones, transfusion requirement, hemoglobin change, infectious complications, or length of hospital stay (p>0.05). Operative time was significantly longer in the Nelaton group (p<0.05), although this difference did not affect clinical outcomes. During catheter removal, four cases of Double-J (DJ) stent migration and one case of stone migration occurred in the Malecot group, whereas no migration-related complications were observed in the Nelaton group. The per-patient cost was significantly lower in the Nelaton group. CONCLUSION: Malecot and Nelaton catheters yield comparable clinical outcomes following mini-PCNL. However, the Nelaton probe offers a significant cost advantage and reduces mechanical complications during catheter removal. It represents a safe and cost-effective alternative for routine cases, although further validation through larger prospective studies is warranted.