The following is a summary of “Percutaneous nephrolithotomy or flexible ureteral lithotripsy, which one is better for patients with upper ureteral calculi of 1.5–2.0 cm in diameter,” published in the April 2024 issue of Urology by Chen et al.

This study presents the first comprehensive evaluation of the clinical efficacy and safety of flexible ureteral lithotripsy (FURSL) and percutaneous nephrolithotomy (PCNL) for the treatment of upper ureteral stones ranging from 1.5 cm to 2.0 cm in diameter, addressing the lack of consensus in managing such ureteral stones.

Between December 2018 and October 2022, 104 patients with upper ureteral calculi underwent either PCNL or FURSL at the institution. Clinical data from both groups were retrospectively analyzed, comparing stone removal rates, operation times, blood loss, postoperative pain scores, inflammatory markers, postoperative complication rates, and ureteral obstruction rates three months post-operation.

Of the 104 patients included, the stone clearance rate was 88.89% in the FURSL group and 97.96% in the PCNL group, with secondary surgery rates of 7.41% and 2.0%, respectively (p = 0.067, 0.497). Ureteral obstruction three months post-operation occurred in 2 patients in the FURSL group and none in the PCNL group (p = 0.497). Patients with PCNL experienced shorter operation times (71.81 ± 18.94 min vs. 86.80 ± 22.49 min, p = 0.0004), fewer complications (20.37% vs. 6.12%), lower postoperative inflammatory markers (p = 0.0004), but higher hemoglobin drop (13.14 ± 9.81 g/L vs. 4.77 ± 3.55 g/L, p < 0.0001), greater postoperative pain scores (p = 0.0017) in the first three postoperative days, and longer hospital stays (4.96 ± 1.21 days vs. 3.60 ± 0.83 days).

Both FURSL and PCNL demonstrated efficacy in treating 1.5–2.0 cm upper ureteral stones, with high stone clearance rates and low secondary surgery rates. FURSL proved advantageous in reducing surgical bleeding, postoperative pain, and hospital stay, while PCNL shortened operation times and lowered the risk of infection and complications. Therefore, individualized selection of surgical treatment based on patient-specific factors is recommended.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01480-1