Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size.
BACKGROUND
The value of flexible ureterorenoscopy (fURS) and miniaturized PNL (mPNL) for larger renal calculi is under discussion. This non-randomized prospective study aimed to evaluate fURS and mPNL for solitary renal stones of 10-30 mm size.


METHODS
fURS was carried out in 21 patients with last generation 7.5F endoscopes. Ureteral access sheaths were used in 19 patients. For mPNL, an 18F modified Amplatz sheath with a 14F nephroscope were used (n = 25). The procedure was performed either tubeless with an antegrade stent or a nephrostomy. Outcome and complications of both procedures were assessed.


RESULTS
Patients' demographics and stone sizes were comparable (18 ± 5 vs. 19 ± 4 mm, P = 0.08). Patients in the fURS group had a higher mean BMI (31 vs. 27, P < 0.05). Total OR time was significantly longer for fURS (106 ± 51 vs. 59 ± 19 min., P < 0.001). More patients were stone-free after one single percutaneous treatment, while 2nd-stage treatments with fURS were common (total procedures 1.04 vs. 1.52, P < 0.001; immediate stone-free rate (SFR) 96% vs. 71.5%, P < 0.001). SFR after 4 weeks was 100% (mPNL) and 85.8% (fURS) (P < 0.01). Minor complications as classified by Clavien I or II occurred in 16 and 23.8%, mPNL and fURS, respectively, P = 0.13). No major complications (Clavien III-V) occured in both groups.


CONCLUSIONS
Our series supports both the concept of either percutaneous or retrograde endoscopic treatment for renal calculi with both modalities offering excellent safety. However, while for fURS, a significantly higher rate of 2nd-stage procedures was necessary, and mPNL led to faster and higher SFR without increasing complication rate.
Department of Urology, Klinikum Sindelfingen-Boeblingen Medical Center, University of Tübingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Germany. t.knoll@klinikverbund-suedwest.de
Thomas
T
Knoll
Jan Peter
JP
Jessen
Patrick
P
Honeck
Gunnar
G
Wendt-Nordahl
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000473:pathology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*