Percutaneous nephrolithotomy (PCNL) is the first-line treatment for staghorn calculi, but infectious complications remain a critical concern. This study evaluated the efficacy and safety of vacuum-assisted access sheaths in single-tract and multi-tract PCNL for partial or complete staghorn stones.

This retrospective study analyzed 216 patients undergoing PCNL between 2018 and 2024. Patients were divided into vacuum-assisted (VA, n=91) and traditional (Control, n=125) groups. Preoperative, intraoperative, and postoperative outcomes, including stone-free rate (SFR), infectious complications, operative time, and recovery duration, were compared using t-tests, chi-square, and logistic regression.

Overall SFR was comparable between groups (51.6% vs. 44.8%, p=0.32). In single-tract PCNL, the VA group demonstrated significantly lower infectious complications (4.4% vs. 21.2%, p=0.01), shorter operative time (94.3±25.9 vs. 112.0±39.9 minutes, p=0.01), and faster recovery (5.0±1.4 vs. 5.8±1.6 days, p=0.01). Multi-tract PCNL showed no significant differences. Logistic regression identified vacuum assistance as protective against infections (OR=0.343, p=0.02).

Vacuum-assisted access sheaths in single-tract PCNL reduce infectious complications, operative time, and recovery duration for staghorn calculi. However, their benefits in multi-tract PCNL were limited, likely due to persistent intrarenal pressure in auxiliary tracts. These findings support the preferential use of vacuum-assisted sheaths in single-tract procedures.