To compare the clinical efficacy of mini-percutaneous nephrolithotomy (MPCNL) and standard percutaneous nephrolithotomy(SPCNL) in the treatment of renal calculi with renal insufficiency.

The data of 193 patients with renal calculi and renal insufficiency who underwent percutaneous nephrolithotomy (PCNL) in Zhongshan People's Hospital Affiliated to Guangdong Medical University from January 2018 to March 2022 were retrospectively analyzed. The stone free rate(SFR), renal function, operation time, blood transfusion rate and complication rate of the two groups, including 117 cases of MPCNL and 76 cases of SPCNL were compared.

There was no significant difference in demographic data between the two groups (P>0.05). The SFR was 72.6% in MPCNL group and 69.7% in SPCNL group, there was no significant difference in SFR between the two groups (P>0.05). The transfusion rate in MPCNL group was significantly lower than that in SPCNL group (7.7% vs 19.7%, P=0.013). The renal function of the two groups was significantly improved at 1 month after operation (P<0.05), but there was no significant difference in the change of renal function between the two groups (P>0.05). There was no significant difference in complications of Clavien-Dindo classification between the two groups (P>0.05). Patients were divided into two groups, CKD3 and CKD4, according to the different stages of CKD. The differences in SFR and postoperative Clavien-Dindo classification complication rates between the two groups were not statistically significant.

MPCNL and SPCNL have good effect in the treatment of patients with renal calculi and renal insufficiency, both have high SFR, and the overall renal function is significantly improved. In addition, MPCNL has lower transfusion rate and shorter hospital stay. MPCNL may be a better treatment for patients with renal calculi and renal insufficiency, especially in patients with CKD3 and CKD4.