Management of Anteriorly Located Renal Caliceal Stones with Two Different Techniques (Mini-Percutaneous Nephrolithotomy vs Flexible Ureteroscopic Laser Lithotripsy): A Critical Comparative Evaluation of the Outcomes.

Abstract

Purpose: To evaluate the efficacy and safety of two different approaches, flexible ureteroscopic laser lithotripsy (fURS) and mini-percutaneous nephrolithotomy (mini-PCNL), for the minimally invasive management of anteriorly located caliceal stones in a location-based manner. Materials and Methods: A total of 93 patients with anterior caliceal stones (<15 mm) were treated with following two different modalities: fURS (n = 52, 55.9%) (Group 1) and mini-PCNL (n = 41, 44.1%) (Group 2). Demographic, per-operative, and postoperative parameters were comparatively evaluated in both groups. Results: The groups were similar in terms of their demographic data and stone characteristics (p > 0.05). Operation, fluoroscopy time, and hospital stay were significantly longer in Group 2 (p < 0.001). The perioperative complication and overall stone-free rates were similar between the groups (p = 0.44 and p = 0.53, respectively). However, when the stone-free rates were examined according to the calix groups, Group 2 was significantly more effective in terms of stone-free rates in the lower calix (52% vs 84%, p = 0.03). Although not statistically significant, more postoperative complications were observed in Group 2 (p = 0.09). Conclusion: Our findings demonstrate that although mini-PCNL may be performed well through a caliceal puncture to remove lower caliceal stones with a high stone clearance rate, the fURS approach may be safer and more rational for the removal of stones located in the middle and upper anterior calices.