{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:57:25Z","timestamp":1790575045481,"version":"4.1.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\u2009\u2264\u20099) and high-risk (S.T.O.N.E. score\u2009&amp;gt;\u20099) 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 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). The 3D-VR-Template group showed further reductions in these indicators and a significantly higher stone-free rate (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). No statistically significant differences existed between the two 3D technology groups. S.T.O.N.E. score\u2009&amp;gt;\u20099 was an independent risk factor for low stone-free rate (OR\u2009=\u20092.31, 95%CI: 1.12\u20134.76,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02). Stratified analysis revealed that while the Simple 3D-VR technique doubled stone-free rate in low-to-moderate risk patients (OR\u2009=\u20092.07, 95%CI: 1.04\u20134.03,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039), the 3D-VR-Template technology provided a superior fourfold advantage (OR\u2009=\u20094.15, 95%CI: 1.07\u20136.14,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.040) specifically in high-risk cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1880578","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T05:45:50Z","timestamp":1790574350000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Three-dimensional virtual reconstruction combined with the S.T.O.N.E. score improves outcomes of PCNL: a multicenter study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jia","family":"Yaodong","sequence":"first","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tian","family":"Guolin","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yajie","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Yongfu","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Yuelong","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Jiaxin","sequence":"additional","affiliation":[{"name":"School of Basic Medical Sciences, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nie","family":"Lihong","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]},{"name":"School of Basic Medical Sciences, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Ruining","sequence":"additional","affiliation":[{"name":"Department of Urology, People\u2019s Hospital of Ningxia Hui Autonomous Region","place":["Yinchuan, Ningxia, China"]},{"name":"The Third Clinical Medical College, Ningxia Medical University","place":["Yinchuan, Ningxia, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1080\/21681805.1976.11882084","article-title":"Percutaneous pyelolithotomy. 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