Resultados comparativos de la mini-PCNL y la ureteroscopia flexible asistida por aspiración en pacientes con litiasis renales ≥ 2 cm

IF 1.7 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2026-10-01 Epub Date: 2026-05-20 DOI:10.1016/j.acuro.2026.501997

H. Mert Durak, A. Sancı, E. Hepşen, O. Burak Karadağ, M. Yığman, K. Sarıkaya, A. Levent Sağnak

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引用次数: 0

Abstract

Introduction

To compare the efficacy and perioperative outcomes of miniaturized percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopy with flexible and navigable suction ureteral access sheath (FANS-UAS) in the management of renal stones larger than 2 cm.

Material and method

This retrospective comparative study evaluated 252 adults with renal stones ≥2 cm treated between May 2024 and December 2025. Mini-PCNL was performed in 142 patients and FANS-UAS–assisted flexible ureteroscopy in 110. Preoperative non-contrast CT was used to characterize stones, and postoperative CT determined stone-free status as the primary endpoint. Operative time, hemoglobin drop, length of stay, Clavien–Dindo complications, and auxiliary intervention rates were analyzed as secondary outcomes.

Results

Stone-free rates did not differ significantly between mini-PCNL and FANS-UAS–assisted flexible ureteroscopy (83.1% vs. 76.4%, p = 0.242). Mini-PCNL provided shorter operative times but resulted in greater hemoglobin decline, longer hospitalization, and more minor complications, while major complications were similar. Although mini-PCNL yielded higher stone-free rates in lower pole stones, this was not statistically significant. FANS-UAS was more frequently applied in older, comorbid patients and maintained satisfactory efficacy with a favorable perioperative profile.

Conclusions

Both mini-PCNL and FANS-UAS–assisted flexible ureteroscopy achieved effective stone clearance for renal stones >2 cm. Mini-PCNL was faster, whereas FANS-UAS was associated with lower perioperative morbidity, despite lower adjusted odds of stone-free status compared with mini-PCNL. These results support an individualized approach to procedure selection in large renal stones, with stone burden, lower pole involvement, and patient comorbidity considered together in treatment planning.

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小型PCNL与吸力辅助柔性尿道镜在肾石症患者中的比较结果≥2 cm

目的：比较微型经皮肾镜取石术（mini-PCNL）与柔性导流输尿管鞘输尿管镜（FANS-UAS）治疗大于2 cm肾结石的疗效及围手术期疗效。材料和方法本回顾性比较研究评估了2024年5月至2025年12月期间治疗的252例肾结石≥2 cm的成年人。142例患者行Mini-PCNL， 110例患者行fans - uas辅助输尿管软镜。术前使用非对比CT对结石进行表征，术后使用CT确定无结石状态作为主要终点。分析手术时间、血红蛋白下降、住院时间、Clavien-Dindo并发症和辅助干预率作为次要结局。结果mini-PCNL输尿管镜与fans - uas辅助输尿管软镜无结石清除率（83.1% vs. 76.4%, p = 0.242）。Mini-PCNL手术时间较短，但血红蛋白下降较大，住院时间较长，轻微并发症较多，而主要并发症相似。尽管mini-PCNL在低极结石中产生更高的无结石率，但这在统计学上并不显著。FANS-UAS更常用于老年合并症患者，并保持满意的疗效和良好的围手术期概况。结论mini-PCNL和fans - uas辅助输尿管软镜均能有效清除2 cm的肾结石。Mini-PCNL更快，而fan - uas的围手术期发病率较低，尽管与Mini-PCNL相比，无结石状态的调整几率较低。这些结果支持在治疗计划中考虑结石负担、下极受累和患者合并症的情况下，对大肾结石进行个体化手术选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.