This study aims to compare the trifecta outcomes—complete stone-free rate (SFR), absence of complications (Clavien-Dindo classification), and no need for auxiliary procedures—between standard percutaneous nephrolithotomy (PCNL) and mini PCNL for the management of renal stones.

Study design: Prospective cohort study.
Duration: January 2022 to March 2024. 

Methodology: A total of 180 patients undergoing PCNL were randomly assigned to two equal groups: standard PCNL (90 patients) and mini PCNL (90 patients). Patients who required a change in the planned surgical procedure were excluded and replaced. Preoperative, perioperative, and postoperative data were collected using a structured proforma. Data analysis was performed using IBM SPSS Statistics, Version 23.0. Logistic regression was applied to assess predictive factors for the trifecta, with odds ratio (OR), confidence interval (CI), and p-value calculation.

The mean age was 43.21 ± 3.51 years in the standard PCNL group and 44.03 ± 3.17 years in the mini PCNL group (p = 0.10). The mean stone size was 30.62 ± 5.88 mm for standard PCNL and 30.28 ± 6.03 mm for mini PCNL (p = 0.70). The complete SFR was significantly higher in the standard PCNL group (93.3%) compared to the mini PCNL group (76.7%) (p = 0.02). Auxiliary procedures were required in 4.4% of standard PCNL cases versus 20% in mini PCNL cases (p = 0.01). The complication rate was higher in the standard PCNL group (17.77%) compared to the mini PCNL group (6.66%) (p = 0.02). Overall trifecta success was achieved in 71.12% of standard PCNL patients and 50.03% of mini PCNL patients (p = 0.01).

Standard PCNL demonstrated superior stone clearance and reduced need for auxiliary procedures. However, it was associated with a higher complication rate compared to mini PCNL. Logistic regression analysis identified standard PCNL as a significant predictor of trifecta success (OR = 2.5, 95% CI 1.3-4.7, p = 0.01).

The trifecta analysis confirms that standard PCNL offers superior stone-free rates and minimizes the need for additional procedures, making it more effective for large renal stones. Conversely, mini PCNL is safer with fewer complications but requires more auxiliary interventions. These findings provide valuable guidance for selecting the appropriate PCNL technique based on patient-specific factors.