Mini-PCNL (percutaneous nephrolithotomy) vs. FURSL (flexible ureteroscopy and laser lithotripsy): a head-to-head comparison in treating calyceal diverticulum stones: a prospective randomized study.

PURPOSE

To compare the efficacy and safety of mini-percutaneous nephrolithotomy versus flexible ureteroscopy with laser lithotripsy in the management of calyceal diverticulum stones.

METHODS

This prospective study was performed on 91 patients across four medical centers in Saudi Arabia from January 2020 to June 2024 with confirmed calyceal diverticulum stones. Seven patients who did not meet the inclusion criteria were excluded. A total of 78 patients with CD stones were randomly divided into two groups: Group A (n = 39) for fURSL and Group B (n = 39) for min-PCNL. Patient demographics, stone complexity and size, operative parameters, and postoperative results were analyzed. Primary and secondary results included stone-free rates (SFRs), operative time, hospital stay, complication rates, and recovery time. Statistical analysis was conducted using SPSS software.

RESULTS

Both groups exhibited comparable baseline characteristics and surgical feasibility. The mini-PCNL group demonstrated a higher SFR (84.62% vs. 71.79%), though the difference was not statistically significant (p = 0.170). Hospital stay was significantly shorter in the fURSL group (17.31 ± 3.06 h vs. 30.03 ± 7.18 h; p < 0.001). Patients undergoing fURSL returned to normal activity sooner (5.1 ± 1.37 days vs. 8.03 ± 1.05 days; p < 0.05). Complication rates were low and similar across groups.

CONCLUSIONS

Both mini-PCNL and fURSL are effective strategies for treating calyceal diverticulum stones. Notably, mini-PCNL offers superior stone-free rates, while fURSL offers shorter operative times, hospital stays, and fast recovery.