Safety and Efficacy of Papillary Versus NonPapillary Access During Percutaneous Nephrolithotomy

This study aims to evaluate and compare the safety, efficacy, and clinical outcomes of papillary and non-papillary renal access during percutaneous nephrolithotomy (PCNL), and to determine whether non-papillary puncture can be considered a safe and effective alternative to the conventional papillary approach in selected patients.

Inclusion Criteria: * Age ≥ 18 years * Solitary or multiple renal calculi ≥2 cm * Ability to provide informed consent Exclusion Criteria: * Bleeding diathesis or uncorrected coagulopathy * Active urinary tract infection at the time of surgery * Congenital anomalies severely distorting renal anatomy (e.g., horseshoe kidney, ectopic kidney) * Morbid obesity \[body mass index (BMI) ≥ 40\] limiting safe positioning * Pregnancy