To evaluate the clinical efficacy and application value of ultrasound-guided two-step terminal needle-free puncture in the treatment of upper urinary tract stones with percutaneous nephropathy (PCNL) for patients with upper urinary tract stones presenting with no or minimal hydronephrosis.

Fifty-one patients with a large amount of hydronephrosis (renal pelvis hydronephrosis≥2.5 cm) who underwent percutaneous nephropathy (PCNL) for upper urinary tract stones at Huai'an Hospital Affiliated to Yangzhou University from March 2022 to December 2024 were randomly divided into an observation group and a control group. Fifty patients with no or minimal hydronephrosis (renal pelvis hydronephrosis＜1 cm) were also divided into an observation group and a control group. The observation groups underwent ultrasound-guided two-step terminal needle-free puncture, while the control groups underwent ultrasound-guided traditional one-step puncture. The following parameters were analyzed and compared between the 2 groups: puncture time (from skin puncture to effluent from the needle sheath), total number of punctures, one-puncture success rate, tract dilation success rate, blood loss (quantified by hemoglobin reduction), immediate postoperative hemoglobin reduction, postoperative complications, stone clearance rate, and other indicators.

In the management of upper urinary tract stones by PCNL, we compared ultrasound-guided two-step terminal needle-free puncture and traditional one-step puncture. The evaluated metrics included puncture duration (from skin puncture to effluent from the needle sheath), total number of punctures, one-puncture success rate, tract dilation success rate, blood loss (quantified by hemoglobin reduction), immediate postoperative hemoglobin reduction, postoperative complications, and stone clearance rate. It was found that in cases with significant hydronephrosis, there were no statistical differences in these parameters between the two groups. However, in cases without hydronephrosis or with minimal hydronephrosis, the ultrasound-guided two-step terminal needle-free puncture group demonstrated significantly shorter puncture duration, fewer punctures, higher one-puncture success rate, higher tract dilation success rate, less inoperative blood loss, less immediate postoperative hemoglobin reduction, and less postoperative complications.

Ultrasound-guided two-step terminal needle-free puncture is safe, feasible, and simple to operate, shortening the learning curve of PCNL. These findings support the clinical adoption of this technique, particularly for PCNL in cases without hydronephrosis or with minimal hydronephrosis.