EFFICACY OF WHIRLPOOL MECHANISM IN RETRIEVAL OF STONE FRAGMENTS (HYDRODYNAMIC STONE RETRIEVAL THROUGH PERCUTANEOUS NEPHROLITHOTOMY) COMPARED TO FORCEPS IN MINI-PERCUTANEOUS NEPHROLITHOTOMY (MINI-PCNL)

Abstract

Mini-percutaneous nephrolithotomy (mini-PCNL) is a widely adopted technique for the treatment of renal stones, offering minimal invasiveness and high success rates. Efficient retrieval of stone fragments is critical for surgical success. This study compares the efficacy and safety of the whirlpool mechanism versus forceps retrieval during mini-PCNL in a tertiary care hospital in Pakistan. Objective: To evaluate the stone clearance rates, operative time, hospital stay, and complications associated with the whirlpool mechanism compared to forceps retrieval in mini-PCNL. Methods: This prospective randomized controlled trial included 90 patients undergoing mini-PCNL at the Institute of Kidney Diseases (IKD), Peshawar. Patients were randomly assigned into two groups: Group A (whirlpool mechanism) and Group B (forceps retrieval), with 45 patients each. Data on stone clearance rates, operative time, hospital stay, and complications were collected and analyzed using SPSS version 26, with a p-value ≤0.05 considered significant. Results: The stone clearance rate was significantly higher in Group A (91.1%) compared to Group B (77.8%, p=0.042). Operative time was slightly longer in Group A (90.6 ± 12.4 minutes) than in Group B (82.3 ± 10.7 minutes, p=0.032). Group A demonstrated a shorter hospital stay (2.8 ± 0.6 days) compared to Group B (3.4 ± 0.7 days, p=0.021). Complication rates, including bleeding, infection, and urinary leaks, were low and comparable between the groups. Conclusion: The whirlpool mechanism significantly enhances stone clearance rates and shortens hospital stays compared to forceps retrieval, with a comparable safety profile. These findings support the adoption of the whirlpool mechanism as a preferred method for stone fragment retrieval during mini-PCNL, particularly in resource-limited settings.