Darwish Amr E, Abdel Moneim Alaa E, Ahmed Abdelfatah I, Hamdy Seif M, Abolella Hassan A, Reda Ahmed
Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Curr Urol. 2024 Dec;18(4):273-277. doi: 10.1097/CU9.0000000000000215. Epub 2024 Dec 20.
Flexible ureterorenoscopy (fURS) and mini-percutaneous nephrolithotomy (mPCNL) have been increasingly used for the treatment of renal stones. However, current guidelines do not recommend one modality over the other. The aim of this study is to compare the safety and efficacy of treatment with fURS versus mPCNL for renal stones sized 2 cm or less.
A prospective, randomized, comparative study was conducted between January 2019 and July 2021 at 3 tertiary care urology centers. Inclusion criteria were adult patients with renal stone(s) ≤ 2 cm with inappropriateness or failure of extracorporeal shock-wave lithotripsy. Subjects were assigned to 1 of 2 treatment groups, either mPCNL or fURS. Two primary outcomes were assessed: (1) initial success rate, defined as the absence of clinically significant residual fragments (>2 mm) on kidney ureter bladder X-ray and ultrasound on the first postoperative day; and (2) complications, which were reported according to the Modified Clavien-Dindo classification system. Secondary outcomes included final success rate, defined as the absence of clinically significant residual fragments on noncontrast computed tomography on the 90th postoperative day; operative time; auxiliary procedures and blood transfusion rates; hemoglobin drop; and length of hospital stay.
One hundred and eighteen procedures were analyzed (59 in each group). The initial success rate of the mPCNL group (93%) was significantly higher than that of the fURS group (70%). Complications occurred more frequently with mPCNL than fURS (44.1% vs. 18.6%, respectively). Final success rate, operative time, and length of hospital stay were comparable between the 2 groups.
Mini-percutaneous nephrolithotomy is more effective than fURS as a single-step treatment for renal stones <2 cm because of its higher initial success rate and lower auxiliary procedure rate. However, mPCNL results in significantly higher complication rates than fURS.
软性输尿管肾镜检查（fURS）和微创经皮肾镜取石术（mPCNL）已越来越多地用于治疗肾结石。然而，目前的指南并未推荐一种方式优于另一种。本研究的目的是比较fURS与mPCNL治疗直径2 cm及以下肾结石的安全性和有效性。
2019年1月至2021年7月在3家三级医疗泌尿外科中心进行了一项前瞻性、随机、对照研究。纳入标准为肾结石直径≤2 cm且体外冲击波碎石术不适用或失败的成年患者。受试者被分配到2个治疗组中的1组，即mPCNL或fURS。评估了两个主要结局：（1）初始成功率，定义为术后第一天肾脏输尿管膀胱X线片和超声检查无临床显著残留碎片（>2 mm）；（2）并发症，根据改良Clavien-Dindo分类系统报告。次要结局包括最终成功率，定义为术后第90天非增强计算机断层扫描无临床显著残留碎片；手术时间；辅助操作和输血率；血红蛋白下降；以及住院时间。
分析了118例手术（每组59例）。mPCNL组的初始成功率（93%）显著高于fURS组（70%）。mPCNL组的并发症发生率高于fURS组（分别为44.1%和18.6%）。两组之间的最终成功率、手术时间和住院时间相当。
微创经皮肾镜取石术作为直径<2 cm肾结石的单步治疗方法比fURS更有效，因为其初始成功率更高且辅助操作率更低。然而，mPCNL导致的并发症发生率显著高于fURS。
