title: Comparison of flexible ureterorenoscopy and micropercutaneous nephrolithotomy in the treatment for moderately size lower-pole stones.
abstract: OBJECTIVE
  To present a retrospective comparative clinical study of micropercutaneous nephrolithotomy (microperc) versus flexible ureterorenoscopy (F-URS) in treatment of moderate-size lower-pole stones (LPSs).
  
  
  METHODS
  We retrospectively reviewed data on patients with isolated LPSs ≤2 cm in diameter treated with F-URS and/or microperc in two referral centers. Patients were divided into two groups by treatment modality: F-URS (Group 1) and microperc (Group 2). Demographics and perioperative parameters were analyzed.
  
  
  RESULTS
  A total of 127 patients with isolated LPSs were treated via F-URS (Group 1, n = 59) and microperc (Group 2, n = 68). Mean patient age in microperc group was slightly lower than in F-URS group (p = 0.112). We found no statistically significant difference in terms of either the size or number of stones in two groups (p = 0.113 and p = 0.209, respectively). Operative time was shorter in microperc, whereas fluoroscopy time was shorter in F-URS (60.1 ± 26.2 vs. 46.2 ± 24.3 min, p < 0.001; and 28.3 ± 19.1 vs. 108.9 ± 65.2 s, p < 0.001). Mean fall in hemoglobin level was statistically significantly lower in F-URS and hospitalization time was also significantly shorter in F-URS (0.68 ± 0.51 vs. 1.29 ± 0.88 mg/dL, p < 0.001; and 23.0 ± 58.1 vs. 33.8 ± 17.2 h, p < 0.001, respectively). Stone-free rates (SFRs) were 74.5 % (44/59) in Group 1 and 88.2 % (60/68) in Group 2 (p < 0.001).
  
  
  CONCLUSIONS
  We found that microperc was safe and efficacious when used to treat moderate-size LPSs and may be considered as an alternative to F-URS, affording a higher SFR. Our study supports the notion that microperc should play an increasing role in treatment of LPSs.
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 34093, Turkey. aarmagantr@gmail.com.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armagan
authors.affiliation: Department of Urology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: Tuna
authors.initials: T
authors.lastname: Karatag
authors.affiliation: Department of Urology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Buldu
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 34093, Turkey.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Tosun
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 34093, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Basibuyuk
authors.affiliation: Department of Urology, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: Mustafa Okan
authors.initials: MO
authors.lastname: Istanbulluoglu
authors.affiliation: Department of Urology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 34093, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000295:instrumentation*
keywords: Comparison; Flexible ureterorenoscopy; Lower-pole stones; Micropercutaneous nephrolithotomy