Three-dimensional virtual reconstruction combined with the S.T.O.N.E. score improves outcomes of PCNL: a multicenter study.

Authors

Jia Yaodong, Tian Guolin, Li Yajie, Chen Yongfu, Feng Yuelong, Yang Hao, Li Jiaxin, Nie Lihong, Zhao Ruining

Published in

Frontiers in surgery. Volume 13. Pages 1880578. Epub Sep 28, 2026.

Abstract

To evaluate the impact of three-dimensional visualization virtual reconstruction (3D-VR) combined with the S.T.O.N.E. score on the efficacy of percutaneous nephrolithotomy (PCNL).
A prospective cohort study enrolled patients with kidney stones from six centers between July 2022 and July 2025. Participants were divided into a conventional ultrasound-guided control group and a 3D-VR group based on the surgical strategy selected by patients after informed consent. The latter group was further subdivided into a Simple 3D-VR group and a 3D-VR-Template group. Each group was further categorized into low-to-moderate risk (S.T.O.N.E. score ≤ 9) and high-risk (S.T.O.N.E. score > 9) subgroups. Perioperative indicators were compared, and the relationship between scores and stone-free rates was analyzed using logistic regression. Stratified multivariable logistic regression analyses were performed to compare 3D-VR techniques against the conventional ultrasound-guided control group across risk-based subgroups (P < 0.05).
No baseline differences were observed among the three groups. Compared with the conventional ultrasound-guided control group, the Simple 3D-VR group alone demonstrated reduced intraoperative blood loss, shorter nephroscopic access establishment time, and shorter hospital stay (P < 0.05). The 3D-VR-Template group showed further reductions in these indicators and a significantly higher stone-free rate (P < 0.05). No statistically significant differences existed between the two 3D technology groups. S.T.O.N.E. score > 9 was an independent risk factor for low stone-free rate (OR = 2.31, 95%CI: 1.12-4.76, P = 0.02). Stratified analysis revealed that while the Simple 3D-VR technique doubled stone-free rate in low-to-moderate risk patients (OR = 2.07, 95%CI: 1.04-4.03, P = 0.039), the 3D-VR-Template technology provided a superior fourfold advantage (OR = 4.15, 95%CI: 1.07-6.14, P = 0.040) specifically in high-risk cases.
Combining 3D-VR with S.T.O.N.E. scoring may optimize PCNL surgical planning, reduce intraoperative bleeding and shorten hospital stay, and may improve stone-free rate especially in patients with high-risk complex stones. Further well-designed controlled studies are warranted to confirm its clinical value.

PMID:
42865735
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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