Clarifying study design in papillary versus non‐papillary access in percutaneous nephrolithotomy: a response to Bicaklioglu

Abstract

Clarifying study design in papillary versus non-papillary access in percutaneous nephrolithotomy: a response to BicakliogluWe sincerely appreciate Dr Bicaklioglu's interest in our study and thoughtful comments [1] regarding our recently published article comparing papillary versus non-papillary access in percutaneous nephrolithotomy (PCNL) [2].Regarding the sample size calculation, we acknowledge the concern raised and would like to emphasise that our estimates were intentionally conservative.Non-papillary access in PCNL has long been subject to criticism, primarily due to its perceived contradiction with classical anatomical studies that have underpinned the principles of endourological renal access for decades.In our work, we intentionally referenced the same foundational anatomical studies that have been used to challenge the safety of non-papillary puncture.Our aim was to apply these studies not to dispute their relevance, but rather to re-interpret their findings in a clinically grounded context.As Dr Bicaklioglu correctly notes, not all anatomical vascular injuries translate into clinically significant bleeding or necessitate transfusion.The challenge, therefore, was to substantiate this assertion with objective data and real-world clinical outcomes, thereby providing a reasoned and evidence-based argument in favour of the safety of non-papillary access under appropriate conditions reasonable enough to persuade the urological community.