Comparison of the effects of mini-percutaneous nephrolithotomy versus flexible ureteroscopic lithotripsy in patients with upper ureteral impacted stones with infection.

Abstract

Background: Urinary stones are a common disease in urology, and stones in ureteral strictures can easily lead to obstruction and subsequent infection. If the upper ureteral impacted stones with infection are not treated promptly, further renal impairment and urinary sepsis can occur. Mini-percutaneous nephrolithotomy (PCNL) and flexible ureteroscopic lithotripsy (fURSL) are common methods for the treatment of upper ureteral impacted stones with infection, but their superiority remains debated. To this end, we designed this study to compare the effects of mini-PCNL versus fURSL in patients with upper ureteral impacted stones with infection.

Methods: The data of 182 patients with upper ureteral impacted stones and infection admitted to The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2024 were retrospectively collected. The patients were divided into an antegrade group (n=88) and a retrograde group (n=94) according to the method they received. The antegrade group was treated with minimally invasive PCNL, and the retrograde group was treated with fURSL. The main outcome measure included inflammatory markers [white blood cell count (WBC), C-reactive protein, interleukin 6, and procalcitonin], and renal function (serum creatinine and urea nitrogen). The other indicators included surgery-related outcomes (operation time and stone-free status) and postoperative complications.

Results: Compared with the retrograde group, the one-time stone clearance rate in the antegrade group was significantly higher (96.59% vs. 86.17%; P=0.03). Compared with that in the retrograde group, the operation time in the antegrade group was significantly longer (62.73±4.82 vs. 51.84±5.02 min; P<0.001). There were no statistically significant differences in leukocyte, C-reactive protein, or interleukin 6 levels between the two groups before treatment (P>0.05). Compared to the retrograde group 3 days after surgery, the antegrade group had a significantly higher WBC [(10.92±2.88 vs. 8.92±2.62)×10⁹/L; P<0.001], C-reactive protein (12.94±4.72 vs. 10.82±4.82 mg/L; P=0.003), and interleukin 6 level (18.74±9.82 vs. 15.81±9.27 ng/L; P=0.04). There was no statistically significant difference in postoperative complications between the two groups (P>0.05).

Conclusions: PCNL can improve stone clearance rate, but the operation time is long and relatively invasive.