Determining the safety and effectiveness of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating nephrolithiasis in patients with solitary kidneys

Flexible ureteroscopy with novel flexible ureteral access sheath versus mini‐percutaneous nephrolithotomy for treatment of 2–3 cm renal stones

“…However, it is imperative to take into account the potential existence of residual stone fragments, as they can give rise to complications such as renal colic, hematuria, the need for additional interventions, and even stone regrowth. 4,9,10,[16][17][18][19] Elevated intrarenal pressure (IRP) during f-URS has posed a significant clinical challenge. The frequent occurrence of high IRP often leads to pyelovenous backflow, which ultimately increases the risk of sepsis.…”

“…[1][2][3] However, with the advancement of endoscopic techniques, an increasing number of urologists are considering flexible ureteroscopy (f-URS) as an alternate method for managing larger than 2 cm renal stones. 4,5 F-URS presents various advantages compared with PCNL, including decreased trauma, lower incidence of complications, and shorter postoperative hospital stay. 6,7 Traditional f-URS has some limitations, such as the potential persistence of stone fragments or dust and the low efficiency of lithotripsy.…”

“…Percutaneous nephrolithotomy (PCNL) is presently regarded as the preferred treatment for renal stones exceeding 2 cm in size 1–3 . However, with the advancement of endoscopic techniques, an increasing number of urologists are considering flexible ureteroscopy (f‐URS) as an alternate method for managing larger than 2 cm renal stones 4,5 . F‐URS presents various advantages compared with PCNL, including decreased trauma, lower incidence of complications, and shorter postoperative hospital stay 6,7 .…”

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

“…In addition to the previous techniques to decrease bleeding, there have been several publications reporting on higher risk bleeding situations, including bilateral PCNL, PCNL on solitary kidneys and PCNL on low-dose aspirin [20,21,22 ▪ ]. Zhang et al 's [20] meta-analysis included five studies comparing bilateral simultaneous PCNL versus staged PCNL.…”

“…As expected, the simultaneous cases were associated with longer operative times and hospital stay, but there were no significant differences between stone-free rate, transfusion rate, fever, hemoglobin drop or overall complications, indicating that simultaneous bilateral PCNL should be an option for patients who require both sides treated. For solitary kidneys with a large stone burden (≥2 cm), PCNL is safe with similar total complication rate as ureteroscopy [21]. Although PCNL is contraindicated in patients on anticoagulation, there is now growing evidence that doing a PCNL on low-dose aspirin is safe.…”