Can flexible nephroscopy, inspection, and calyceal examination (NICE) post suction mini percutaneous nephrolithotomy improve zero and overall stone free rate? an EAU endourology and AUSET collaboration study

Xiao K. Gauhar V. Castellani D. Kalathia J. Gadzhiev N. Malkhasyan V. Kumar N. Gokce M.I. Tak G.R. Beltrán‑Suárez E. Fong K.Y. Skolarikos A. Acuña E. Zawadzki M. Kamal W. Lopes L.G. Talyshinskii A. Tsaturyan A. Pietropaolo A. Zhu W. Zeng G. Somani B.K. Herrmann T.R.W. Yuen S.K.K.
December 2026 Springer Science and Business Media Deutschland GmbH

World Journal of Urology
2026 #44 Issue 1

Abstract: To assess if adjunct flexible Nephroscopy, Inspection, and Calyceal Examination (NICE) improves stone-free rate (SFR) after suction mini-percutaneous nephrolithotomy (SM-PCNL). This prospective multicenter study included 1534 SM-PCNL patients (March-November 2024) from 30 centers across 21 countries. Post intervention, patients underwent calyceal inspection via fluoroscopy alone (Group 1, n = 1022) or fluoroscopy plus NICE (performed via antegrade flexible nephroscopy or retrograde ureteroscopy) (Group 2, n = 512) to check for per operative injury and stone clearance. Stone-free status (SFS) was assessed by 30-day non-contrast CT (NCCT): Grade A (zero residual fragments, ZRF), B (single ≤4 mm), or C (> 4 mm/multiple). Group 2 had larger stones (diameter: 22 mm vs. 19 mm, volume: 2100 mm³ vs. 1498 mm³, p < 0.001), higher Guy’s stone scores (Grade 2–4: 54.5% vs. 43.9%, p < 0.001), and longer operative times (55 vs. 42 min, p < 0.001). Notably, Group 2 exhibited significantly lower ZRF (75.6% vs. 86.6%), higher Grade B (18.9% vs. 11.9%) and Grade C fragments (7.0% vs. 3.7%, p < 0.001). Multivariate analysis revealed the odds of ZRF did not improve with NICE (OR 0.69, 95%CI 0.50–0.95; p = 0.024) and increased 30-day reinterventions (4.5% vs. 1.5%; p < 0.001). Complications were comparable (10.5% vs. 11.3%, p = 0.677). Intraoperative SFS assessment correlated better with NCCT in Group 1 (81.2% vs. 76.0%; p = 0.017), with superior accuracy in identifying ZRF (90.4% vs. 84.1%; p = 0.001). In SM-PCNL, the use of NICE in complex cases was not associated with improved ZRF or overall SFR (Grade A + B) compared to fluoroscopy alone, despite its preferential use in more challenging scenarios. Fluoroscopy alone showed better intraoperative-NCCT correlation for residual fragments and shorter operative times. Based on these findings, routine use of NICE in SM-PCNL is not supported. Its selective application may be considered in complex cases where direct visualisation is deemed crucial.

Nephroscopy, inspection, and calyceal examination (NICE) , Prospective multicenter study , Residual fragments , Stone free rate , Suction mini-PCNL

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Department of Urology, Guangdong Provincial Key Laboratory of Urological Diseases, Guangdong Engineering Research Center of Urinary Minimally Invasive Surgery Robot and Intelligent Equipment, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Urology, Guangzhou, China
Endourology Section of the European Association of Urology, Arnhem, Netherlands
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
Asian Institute of Nephrourology, AINU, Chennai, India
Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Via Conca 71, Ancona, 60126, Italy
Fortune Urology Clinic, Gujarat, Botad, India
Department of Urology, Saint-Petersburg State University Hospital, Saint- Petersburg, Russian Federation
Department of Urology, Moscow Urology Center, Botkin Hospital, Moscow, Russian Federation
Department of Urology, Ford Hospital and Research Centre, Bihar, Patna, India
Department of Urology, Ankara University School of Medicine, Ankara, Turkey
Department of Urology, Asian Institute of Nephrology and Urology, Telangana, Hyderabad, India
Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
Department of Urology, Sengkang General Hospital, Singapore, Singapore
Second Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
Department of Urology, Institution Hospital Provincial de Ovalle, Coquimbo, Ovalle, Chile
Urology Unit, St. Anna Hospital, Piaseczno, Poland
Urology Unit, King Fahd General Hospital, Jeddah, Saudi Arabia
Department of Urology, Hospital Orizonti and Santa Casa de, Minas Gerais, Belo Horizonte, Brazil
Department of Urology, Astana Medical University, Astana, Kazakhstan
Department of Urology, Erebouni Medical Center, Yerevan State Medical University, Yerevan, Armenia
Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, Stellenbosch, South Africa
Hannover Medical School, Hannover, Germany
Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Sha Tin, Hong Kong

Department of Urology
Endourology Section of the European Association of Urology
Department of Urology
Asian Institute of Nephrourology
Urology Unit
Fortune Urology Clinic
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Second Department of Urology
Department of Urology
Urology Unit
Urology Unit
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Division of Urology
Hannover Medical School
Department of Surgery

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