[Efficacy and safety of flexible ureteroscopy with a navigable suction ureteral access sheath versus mini-percutaneous nephrolithotomy for 23 cm renal stones: a retrospective study].

INTRODUCTION Flexible ureteroscopy using a flexible and navigable suction ureteral access sheath (FANS f-URS) has expanded the possibilities of endoscopic treatment of renal stones; however, its role in the management of renal stones more or equal 2 cm remains controversial.

Aim

To compare the efficacy and safety of FANS f-URS and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 2-3cm renal stones.

Materials And Methods

This retrospective study included 39 patients who underwent endoscopic surgical treatment, including 19 patients who underwent FANS f-URS and 20 who underwent mini-PCNL. Baseline characteristics as well as intraoperative and postoperative outcomes were collected and compared between the two groups.

Results

On the first postoperative day, the stone-free rate, defined as residual fragments less or equal 2 mm, was 78.9% in the FANS f-URS group and 50.0% in the mini-PCNL group (p=0.096). At 3 months, the stone-free rates were comparable (94.7% for FANS f-URS and 90.0% for mini-PCNL; p>0.999). FANS f-URS was associated with a smaller decrease in hemoglobin level (p<0.001), a lower postoperative leukocyte count (p=0.023), and a shorter hospital stay (p<0.001; the proportion of patients with a hospital stay of 1-2 days was 100.0% vs. 40.0%). The complication rate and incidence of infectious events did not differ between the groups. Both groups demonstrated a statistically significant improvement in quality of life, with no difference in the magnitude of change between the groups (p=0.081).

Conclusion

FANS f-URS provides efficacy comparable to that of mini-PCNL for 2-3 cm renal stones, while offering a more favorable safety profile and postoperative recovery.