Comparison of efficacy and safety between flexible ureteroscopy-assisted percutaneous nephrolithotomy and percutaneous nephrolithotomy monotherapy for the treatment of complicated renal calculi

Objective: Percutaneous Nephrolithotomy (PCNL) is one of the most effective methods for treating renal calculi. However, complicated renal calculi cannot be completely cleared through rigid nephroscopy with a single tract, whereas PCNL using multiple tracts increases the surgical risk and prolongs the post-operative recovery time. Multi-functional ureteroscopy with active and passive flexibility could provide an alternative option for the treatment of complicated renal calculi. This study aimed to compare the efficiency and safety between flexible ureteroscopyassisted percutaneous nephrolithotomy (FURA-PCNL) and percutaneous nephrolithotomy (PCNL). Methods: From January 2013 to August 2014, 168 patients who underwent either PCNL or FURA-PCNL were included in this retrospective study. Major outcomes including stone free rate and postoperative complications were then compared between these two surgical groups. Other pre-operational and peri-operational parameters were also analyzed. Results: Ninety patients received PCNL and 78 received FURA-PCNL. The average surgical time for FURA-PCNL was significantly shorter than for PCNL (P<0.05). Both the decreases in the hemoglobin and the damages to renal function were milder for FURA-PCNL versus PCNL (P<0.05). The stone-free rate for FURS-PCNL was significantly higher than PCNL. Based on the Clavien grade, the postoperative complication rate was similar between two treatments (P>0.05). Conclusions: This study demonstrates that FURS-PCNL is safer, more efficient, and more versatile compared to PCNL for the treatment of complicated renal calculi.