A research on flexible ureteroscope lithotripsy versus percutaneous nephrolithotomy for upper urinary tract calculi

Objective: To compare the efficacies of flexible ureteroscope lithotripsy (FURL) and percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract calculi (UUTC). Methods: In this retrospective study, 97 patients with UUTC were divided into FURL group (n=49) and PCNL group (n=48) according to the treatment methods. The primary outcomes (operation time, length of hospital stay, and stone clearance rate), and secondary outcomes (incidences of postoperative complications and S.T.O.N.E. nephrolithometry scoring) in the two groups were recorded and compared. Results: The operation time of FURL group was longer than that of PCNL group (P<0.05), and the length of hospital stay of FURL group was shorter than that of PCNL group (P<0.05). The stone clearance rate of FURL group with stone diameter 3.1-4.0 cm was lower than that of PCNL (P<0.05), and the two groups had no difference in the total stone clearance rate (P>0.05). The total incidence of postoperative complications of FURL group was lower than that of PCNL group (P<0.05). S.T.O.N.E. nephrolithometry scoring showed equal efficacies in the patients with 6-8 scores. The results of multivariate regression analysis showed that size of stones and S.T.O.N.E. nephrolithometry scoring were independent risk factors for stone clearance rate (both P<0.05). Conclusion: Compared with PCNL, FURL had an effect on UUTC when the stones were under 3 cm, and the stone clearance rate of patients with 6-8 S.T.O.N.E. nephrolithometry scores could be effectively predicted.