Hypothesis / aims of study
Introduction and Objectives:
Percutaneous nephrolithotomy (PCNL) remains the gold standard for treating large renal stones.
However, fragment migration, prolonged operative time, and post-operative complications pose
challenges. The Saeedi Approach, which integrates PCNL with ureteroscopy (URS), employs a large-
caliber access sheath (24 Fr) and a small nephroscope (19 Fr) to optimize stone clearance. This technique
enhances maneuverability, leverages passive vacuum evacuation for large fragments, and minimizes the
need for prolonged lithotripsy, irrigation pressure, and auxiliary procedures.
Study design, materials and methods
Materials and Methods:
A retrospective study of 70 patients (renal stones >2 cm) treated with the Saeedi Approach between
January 2021 and June 2024 was conducted. The supine position was utilized to aid gravity-assisted
clearance. Parallel triangulation aligned renal and ureteral access points, preventing fragment migration.
The gap between the nephroscope and sheath created a passive suction effect, reducing the need for
active irrigation. A rubber band seal was used to improve irrigation flow.
Results
Results:
- 95% stone-free rate achieved after single procedure (67/70 patients).
- Operative time significantly reduced (75 minutes vs. standard PCNL time of 90–120 minutes, p <
0.001).
- Post-operative complications lower (χ² = 6.37, p = 0.01), with minimal infections (χ² = 2.67, p =
0.10).
- 85% tubeless PCNL rate, reducing patient discomfort and hospital stay.
- Passive vacuum evacuation accelerated fragment clearance, reducing lithotripsy time.
- Shorter hospitalization (1–2 days vs. standard PCNL stay of 3–5 days, p < 0.001) due to improved
efficiency and reduced complications.
Interpretation of results
The Saeedi Approach offers several advantages over traditional PCNL. The combined use of PCNL and URS, guided by parallel triangulation, allows for simultaneous management of renal and ureteral stones, preventing fragment migration and reducing the need for secondary procedures. The large-caliber access sheath and mini-nephroscope provide enhanced maneuverability and facilitate efficient stone fragmentation and removal. Gravity-assisted evacuation through the sheath further contributes to complete stone clearance. The data indicate a shorter operative time, lower complication rates, and quicker recovery compared to historical controls for traditional PCNL, suggesting the Saeedi Approach’s potential to improve patient outcomes.
Concluding message
Conclusion:
The Saeedi Approach enhances PCNL efficiency through superior maneuverability, passive vacuum-
assisted stone evacuation, and reduced irrigation pressure, leading to shorter operative time, fewer
complications, and a significantly reduced hospital stay compared to standard PCNL. This innovative
technique holds significant promise for improving PCNL outcomes and warrants further multi-center
validation.