Comparison between tubeless mini-percutaneous nephrolithotomy versus flexible ureterorenoscopic lithotripsy for the treatment of upper ureteral calculi larger than 1 cm

Background: This study aimed to assess the outcome and safety of tubeless mini-percutaneous nephrolithotomy (mPCNL) and flexible ureterorenoscopic lithotripsy (fURSL) in treating upper ureteral stones larger than 1 cm.Materials and Methods: Between July 2017 and June 2020, 218 patients who underwent tubeless mPCNL and fURSL for upper ureteral calculi larger than 1 cm were enrolled in this study. Patient characteristics and perioperative outcomes and complications were evaluated by retrospective chart review.Results: Immediate stone-free rates after the procedure were 100% of patients for the tubeless mPCNL and 71.0% of patients for the fURSL group (P = 0.004). The mean +/- SD operative time per patient was 79.8 +/- 21.8 minutes in the tubeless mPCNL group, and it was 99.7 +/- 33.8 minutes in the fURSL groups (P = 0.009). The average hospital stay was 2.7 +/- 1.9 days in the tubeless mPCNL group and 1.5 +/- 1.2 days in the fURSL group (P < 0.001). The rates of febrile episode for the tubeless mPCNL and fURSL groups were 14.3% and 2.3%, respectively (P = 0.028)Conclusions: Tubeless mPCNL and fURSL are safe and feasible treatment options for proximal ureteral calculi larger than 1 cm. Tubeless mPCNL offers better outcome of higher stone-free rate and shorter operation time compared with fURSL but with a higher rate of febrile complications and longer hospital stay.