title: Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10-35 mm.
abstract: OBJECTIVE
  To compare ultra-mini PCNL (UMP) and flexible ureteroscopy (fURS) for the treatment of medium- to large-sized renal stones with a focus on patients' postsurgical cumulative analgesic consumption and treatment-related satisfaction.
  
  
  METHODS
  Twenty-five patients treated by UMP between April 2013 and October 2014 were matched to data of 25 fURS patients from an existing database. Clinical outcome parameters were recorded prospectively. Postoperative analgesic consumption was assessed using the Cumulative Analgesic Consumption Score (CACS), and satisfaction was measured with the Freiburg Index of Patient Satisfaction (FIPS) questionnaire.
  
  
  RESULTS
  Perioperative outcome parameters showed no significant differences except for mean operating times (fURS 98.52 min, UMP 130.12 min [p = 0.002]) and hospital stay (fURS 67.2 h, UMP 91.5 h [p = 0.04]). Primary stone-free rate was 96 % in fURS and 92 % in UMP. Complications Clavien grade 2 or 3 occurred in 16 % of UMP patients and in 4 % of fURS patients. Postsurgical cumulative analgesic consumption was almost identical in both groups with CACSs of 6.96 (0-15) for fURS and 6.8 (0-23) for UMP. Patients' satisfaction was high in both techniques: FIPS score in fURS 1.67 (1-3) and 1.73 (1-4) in UMP (scale 1-6).
  
  
  CONCLUSIONS
  Treatment of medium- to large-sized renal stones is safe and highly effective by both UMP and fURS. Moreover, both treatments yield comparable postsurgical analgesic requirements and high patient satisfaction scores. Patient-related factors (anatomical and stone related) and availability of technical equipment and surgical expertise appear to be the most important determining factors in treatment planning.
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany. konrad.wilhelm@uniklinik-freiburg.de.
authors.forename: Konrad
authors.identifier: http://orcid.org/0000-0002-2634-1095
authors.initials: K
authors.lastname: Wilhelm
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Hein
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Adams
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schlager
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Miernik
authors.affiliation: Department of Surgery, Clinic for Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schoenthaler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Analgesic consumption; Pain; Patient satisfaction; Percutaneous nephrolithotomy; RIRS; URS; Ultra-mini PCNL; Ureteroscopy; Urolithiasis