Prevention of ureteral stone migration during percutaneous nephrolithotomy: a randomized controlled trial
In brief
Occlusion balloon catheter cuts ureteral stone migration from 17% to 4%
In a randomized trial of 99 patients undergoing totally tubeless percutaneous nephrolithotomy, use of an occlusion balloon catheter lowered the rate of post-procedure ureteral fragments to 4% versus 17% with a standard 5 Fr open-ended catheter-a roughly 80% risk reduction. The benefit was seen without differences in operative time, but the clinical significance of the few residual fragments remains unclear.
- Journal
- World journal of urology (Q1)
- Published
- 2 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ziv Savin, Evan Garden, Kavita Gupta, Juan S Serna, Eve Frangopoulos, Vinay Durbhakula, et al.
- PMID
- 42543393
- DOI
- 10.1007/s00345-026-06666-w
Why clinicians should know about it
- Picked for Urology (top studies of the week, 9 August 2026): Use of occlusion balloon catheter significantly reduced fragment migration
Abstract
OBJECTIVE: With the increasing adoption of totally tubeless percutaneous nephrolithotomy (ttPCNL), prevention of stone fragment migration into the ureter has gained clinical importance. This study aimed to compare the incidence of ureteral fragment migration at the end of PCNL using a 5 Fr open-ended ureteral catheter (5FrUC) versus an occlusion balloon catheter (OBC). METHODS: In this IRB-approved randomized controlled trial, 108 eligible patients were randomized 1:1 to either the 5FrUC or OBC group and 99 were included in the final analysis. The primary outcome, ureteral fragment migration, was defined as the presence of any stone fragment ≥ 1 mm between the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), confirmed by ureteroscopy at the conclusion of PCNL. RESULTS: Baseline demographics, stone characteristics, and operative parameters were comparable between groups, confirming effective randomization. Ureteral fragments were detected in 10 patients (10%): 7 with a single fragment, 2 with two fragments, and 1 with more than three fragments. The median fragment size was 2 mm (range, 1-4 mm). The incidence of ureteral fragments was significantly higher in the 5FrUC group compared with the OBC group (17% vs. 4%, p = 0.03). Logistic regression analysis demonstrated that OBC use reduced the risk of ureteral fragment migration by approximately 80% compared with 5FrUC (OR = 0.204, 95%CI 0.041-1.001, p = 0.05). Greater total stone burden, larger stone volume, higher Guy's stone score, and presence of full staghorn calculi were also associated with fragment migration. CONCLUSION: Use of an occlusion balloon catheter significantly reduced ureteral fragment migration compared with a 5 Fr open-ended ureteral catheter, achieving prevention in 96% of cases. Although the clinical impact of residual ureteral fragments remains uncertain, these findings support consideration of OBC use, particularly in ttPCNL procedures.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.