Comparison between Retrograde Flexible Ureteroscopy and Percutaneous Nephrolithotomy for the Treatment of Renal Stones of 2–4 cm

Abstract

Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm

“…RIRS is not recommended for stones exceeding 2 cm in diameter because it achieves worse stone clearance outcomes than does PCNL, engendering the need for staged procedures for effective treatment [ 20 ]. Another study revealed that although RIRS has proven effective in treating renal stones of 2–4 cm, it is crucial to acknowledge that multiple procedures may be necessary to address the entire stone burden completely [ 21 ]. A recent meta-analysis demonstrated that RIRS is a safe and efficient procedure for specific patients with large renal stones; nevertheless, PCNL was demonstrated to have a higher postoperative stone clearance rate than RIRS in patients with renal stones larger than 2 cm did [ 22 ].…”

Impact of frailty on perioperative outcomes following percutaneous nephrolithotomy in older persons: evidence from the US Nationwide Inpatient Sample

“…Notably, older patients face a higher risk of complications related to kidney stones, and are twice as likely to require hospitalization [7, 8], which indicates there is a need to provide special attention and care to this population.Percutaneous nephrolithotomy (PCNL) is the first-line intervention for the management of complex kidney stones, and effectively can remove stones through a minimally invasive approach [9]. Compared to shockwave lithotripsy and flexible ureteroscopy, PCNL is associated with a higher success rate and stone-free rate [10][11][12]. Despite its advantages, this procedure can lead to potential complications Yaw-Jen Chang…”

“…Percutaneous nephrolithotomy (PCNL) is the first-line intervention for the management of complex kidney stones, and effectively can remove stones through a minimally invasive approach [9]. Compared to shockwave lithotripsy and flexible ureteroscopy, PCNL is associated with a higher success rate and stone-free rate [10][11][12]. Despite its advantages, this procedure can lead to potential complications Yaw-Jen Chang…”