Photo Credit: Mono

The study compares micro percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) for treating 1 to 2 centimeter single upper ureteral calculi, revealing that while MPCNL has a shorter operation time and higher stone-free rate, FURS offers a shorter hospitalization duration, and both procedures exhibit similar complication rates.

The following is a summary of “Comparison of percutaneous nephrolithotomy and flexible ureterorenoscopy in the treatment of single upper ureteral calculi measuring 1 to 2 centimeters: a retrospective study,” published in the January 2024 issue of Urology by He et al.

This study aimed to comprehensively compare the efficacy and safety between micro percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURS) for treating single upper ureteral calculi measuring 1 to 2 centimeters.

Medical records were meticulously reviewed in this retrospective analysis alongside an outcomes management database. A total of 163 patients undergoing MPCNL and 137 patients undergoing FURS between January 2017 and December 2021 were identified for inclusion. Demographic data, operation time, hospitalization duration, stone-free rate, and complication rate were systematically collected and subjected to thorough analysis.

The preoperative general data, encompassing variables such as sex, age, BMI, serum creatinine, stone existence duration, stone hardness, stone diameter, preoperative hydronephrosis, and preoperative infection, exhibited no statistically significant differences between the MPCNL and FURS groups. Notably, all MPCNL and FURS procedures in both groups were successfully completed without instances of reoperation or conversion to alternative surgical procedures. While MPCNL demonstrated a significantly reduced operation time (49.6 vs. 72.4 min; P<0.001), it was associated with a longer hospitalization duration compared to FURS (9.1 vs. 3.9 days; P<0.001). The MPCNL group exhibited a superior stone-free rate to the FURS group (90.8% vs. 71.5%; P<0.001). Importantly, there was no statistically significant difference in the complication rates between the two groups (13.5% vs. 15.3%; P = 0.741).

Both MPCNL and FURS emerge as viable and secure surgical options for individuals with solitary upper ureteral calculi measuring 1 to 2 cm. While FURS offers a shorter hospitalization duration, it is associated with a lower stone-free rate and a longer operative time than MPCNL. 

Importantly, the two procedures had no substantial differences in the complication rates. The choice between FURS and MPCNL should be made considering the surgeon’s expertise, the quality of equipment, and patient preferences, with FURS being favored for uncomplicated cases and MPCNL for complicated upper ureteral calculi.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01408-9