Retrospective, multicenter evaluation of outcome in percutaneous nephrolitholapaxy using different energy sources for lithotripsy

Retrospective, multicenter evaluation of outcome in percutaneous nephrolitholapaxy using different energy sources for lithotripsy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Retrospective, multicenter evaluation of outcome in percutaneous nephrolitholapaxy using different energy sources for lithotripsy Maximillian Reinahrd Müller, Marco Julius Schnabel, Sarina Herrig, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9114141/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: Mini percutaneous nephrolithotomy (mini-PNL) is an effective treatment for large renal stones, offering high stone clearance rates with low complication risks. This study aimed to compare the efficacy and safety of holmium YAG laser, ballistic, and ultrasound lithotripsy during mini-PNL. Methods: This multicenter prospective study analyzed 125 patients who underwent mini-PNL using either laser, ballistic, or ultrasound lithotripsy. Efficacy was assessed based on the stone-free rate (evaluated endoscopically and via fluoroscopy) and intrarenal surgery time adjusted for stone volume. Stone volume was estimated using automated CT-based computation when available or calculated using the ellipsoid volume formula. Complications were classified according to the Clavien-Dindo system. Results: A total of 125 patients (59 in Regensburg, 66 in Trier) were included. The primary energy sources were laser (54.4%) and EMS Trilogy (44%). In Regensburg, lithotripsy was performed using a laser in 96.6% of cases, whereas in Trier EMS Trilogy was used in 81.8% and laser in 16.7% of cases. The median intrarenal operative time was shorter with laser compared to EMS Trilogy (28.5 min vs. 35 min; p = 0.033). After adjustment for stone volume, the difference remained significant (mean difference = −18.77 min; p = 0.0001). There were no significant differences regarding stone-free rate (SFR) (laser 85.3% vs. EMS 72.8%; p = 0.222) or reintervention rate (laser 19.1% vs. EMS 23.6%; p = 0.8706). Postoperative complications occurred independently of the method used (Grade 1–2: laser 13.2% vs. EMS 29%; Grade 3–4: laser 5.9% vs. EMS 1.8%; p = 0.138). In the univariate analysis, higher BMI was associated with an increased rate of complications (p = 0.04). Conclusion: Compared with laser lithotripsy, the use of EMS Trilogy for stone fragmentation was associated with a significantly longer operative time, while complication rates and stone-free rates did not differ significantly. Kidney stones Mini-PCNL Minimally invasive-percutaneous nephrolithotomy Nephrolithiasis PCNL Percutaneous nephrolithotomy Stone-free rate Re do PCNL Urolithiasis [MeSH] Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Mar, 2026 Editor assigned by journal 14 Mar, 2026 Submission checks completed at journal 14 Mar, 2026 First submitted to journal 13 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9114141","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607401372,"identity":"e55a78f9-810c-45af-bd99-d2012b5ecaea","order_by":0,"name":"Maximillian Reinahrd 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Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Kidney stones, Mini-PCNL, Minimally invasive-percutaneous nephrolithotomy, Nephrolithiasis, PCNL, Percutaneous nephrolithotomy, Stone-free rate, Re do PCNL, Urolithiasis [MeSH]","lastPublishedDoi":"10.21203/rs.3.rs-9114141/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9114141/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: Mini percutaneous nephrolithotomy (mini-PNL) is an effective treatment for large renal stones, offering high stone clearance rates with low complication risks. This study aimed to compare the efficacy and safety of holmium YAG laser, ballistic, and ultrasound lithotripsy during mini-PNL.\u003c/p\u003e\n\u003cp\u003eMethods: This multicenter prospective study analyzed 125 patients who underwent mini-PNL using either laser, ballistic, or ultrasound lithotripsy. Efficacy was assessed based on the stone-free rate (evaluated endoscopically and via fluoroscopy) and intrarenal surgery time adjusted for stone volume. Stone volume was estimated using automated CT-based computation when available or calculated using the ellipsoid volume formula. Complications were classified according to the Clavien-Dindo system.\u003c/p\u003e\n\u003cp\u003eResults: A total of 125 patients (59 in Regensburg, 66 in Trier) were included. The primary energy sources were laser (54.4%) and EMS Trilogy (44%). In Regensburg, lithotripsy was performed using a laser in 96.6% of cases, whereas in Trier EMS Trilogy was used in 81.8% and laser in 16.7% of cases. The median intrarenal operative time was shorter with laser compared to EMS Trilogy (28.5 min vs. 35 min; p = 0.033). After adjustment for stone volume, the difference remained significant (mean difference = −18.77 min; p = 0.0001). There were no significant differences regarding stone-free rate (SFR) (laser 85.3% vs. EMS 72.8%; p = 0.222) or reintervention rate (laser 19.1% vs. EMS 23.6%; p = 0.8706). Postoperative complications occurred independently of the method used (Grade 1–2: laser 13.2% vs. EMS 29%; Grade 3–4: laser 5.9% vs. EMS 1.8%; p = 0.138). In the univariate analysis, higher BMI was associated with an increased rate of complications (p = 0.04).\u003c/p\u003e\n\u003cp\u003eConclusion: Compared with laser lithotripsy, the use of EMS Trilogy for stone fragmentation was associated with a significantly longer operative time, while complication rates and stone-free rates did not differ significantly.\u003c/p\u003e","manuscriptTitle":"Retrospective, multicenter evaluation of outcome in percutaneous nephrolitholapaxy using different energy sources for lithotripsy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-23 23:43:11","doi":"10.21203/rs.3.rs-9114141/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-17T07:23:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-14T06:36:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-14T06:35:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Urolithiasis","date":"2026-03-13T11:16:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"urolithiasis","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ures","sideBox":"Learn more about [Urolithiasis](http://link.springer.com/journal/240)","snPcode":"240","submissionUrl":"https://submission.nature.com/new-submission/240/3","title":"Urolithiasis","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fa5f272c-d8b3-42c7-bc6a-961b985c994d","owner":[],"postedDate":"March 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T23:43:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-23 23:43:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9114141","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9114141","identity":"rs-9114141","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}