Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Flexible ureteroscopy, extracorporeal shock wave lithotripsy and mini percutaneous nephrolithotomy for management of lower pole renal hard stones ≤ 2 cm: a prospective randomized study,” published in the December 2024 issue of Urology by Zeinelabden et al. 

Lower pole renal stones pose clinical challenges due to factors like size, location, and density. 

Researchers conducted a retrospective study to evaluate the efficacy, safety, and stone-free rates of Flexible Ureteroscopy (FURS), Extracorporeal Shock Wave Lithotripsy (ESWL), and Mini Percutaneous Nephrolithotomy (Mini PCNL) for treating lower pole renal hard stones (< 2 cm). 

They conducted a prospective single-center study on 414 adult patients with primary lower pole renal hard stones. The patients were equally divided into 3 groups: FURS with holmium laser lithotripsy, ESWL, and Mini PCNL with holmium laser lithotripsy. 

The results showed statistically significant differences among groups in stone-free rates, hospital stay, radiation exposure, operative duration, auxiliary treatments, and overall cost (P < 0.001). No significant differences were found in demographic data (P = 0.245) or complication rates (P = 0.611). At the 2-week follow-up, stone-free rates were 90.2% for FURS, comparable with Mini PCNL, and significantly higher than ESWL (61.5%). 

Investigators found that mini PCNL and FURS had comparable stone-free rates for moderate-sized, hard lower pole renal stones, with FURS offering fewer complications. Based on these findings, FURS was recommended for managing such stones. 

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-024-01644-z