Presented by: Sai Vangala MD
Northern Ontario School of Medicine

Introduction

We compared the safety and efficacy of flexible ureteroscopy (F-URS) and ambulatory tubeless mini-percutaneous nephrolithotomy (mini-PCNL) in the treatment of 1-2 cm lower calyceal renal stones.

Materials

Patients who underwent F-URS and mini-PCNL for the treatment of 1-2 cm lower calyceal renal stones between October 2020 and July 2022 were evaluated in a randomized controlled trial. Sixty-four participants were included in the study thus far. All participants underwent a CT renal colic scan preoperatively, on postoperative day one (POD 1), and at 3 months follow-up. Outcome measures including stone characteristics, operative time, hospital stay, stone-free rate (SFR) in addition to complication rates were collected and compared. All patients were discharged home on the same operative day.

Results

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There were no significant differences in preoperative baseline data between the two surgical groups. A significantly longer median operative time was reported in the mini-PCNL group (p=0.04). The median hospitalization time was 5 hours and 4 hours in the mini-PCNL and F-URS groups, respectively (p=0.14). The SFR on POD-1 was 23.5% in the F-URS group and 80% in the mini-PCNL group (p<0.001). At 3 months follow-up, the SFR was 67.6% in the F-URS group and 90% in the mini-PCNL group (p=0.03). There was no significant difference in hemoglobin drop or postoperative complications between the two groups. One patient in the F-URS group required retreatment.

Conclusion

Ambulatory mini-PCNL and F-URS are effective treatment options for 1-2 cm lower calyceal stones. Both techniques have comparable hospital stay and complication rates, with a significantly better stone-free rate with mini-PCNL.

Funding

None

Co-Authors

Hazem Elmansy,
Northern Ontario School of Medicine

Moustafa Fathy,
Northern Ontario School of Medicine

Amr Hodhod,
Northern Ontario School of Medicine

Amer Alaref,
Northern Ontario School of Medicine

Parsa Nikoufar,
Northern Ontario School of Medicine

Ahmed S Zakaria,
Northern Ontario School of Medicine

Abdulrahman Alkandari,
Northern Ontario School of Medicine

Ruba Abdul Hadi,
Northern Ontario School of Medicine

Loay Abbas,
Northern Ontario School of Medicine

Waleed Shabana,
Northern Ontario School of Medicine

Ahmed Kotb,
Northern Ontario School of Medicine

Walid Shahrour,
Northern Ontario School of Medicine