Comparison of the Efficacy of Ureteroscopy through a Flexible Vacuum-Assisted Ureteral Access Sheath with Tubeless-mini Percutaneous Nephrolithotomy for the Treatment of 2-3 cm Renal Calculi.

Purpose: To investigate the efficacy of the flexible vacuum-assisted ureteral access sheath (FV-UAS) combined with disposable flexible ureteroscope (FURS) versus tubeless-mini percutaneous nephrolithotomy(T-PCNL) in the treatment of renal calculi with a diameter of 2-3 cm.

Materials and methods: This retrospective analysis included 270 patients of renal calculi with a maximum diameter of 2-3 cm treated between January 2022 to July 2024. Of these, 146 cases were treated with single use ureteroscopic lithotripsy through a FV-UAS while 124 cases were treated by tubeless PCNL (T-PCNL group) through 16F amplatz sheath. Perioperative indicators and postoperative stone-free rates (SFR) were compared.

Results: There was no significant difference in the stone free rates（SFRs） between the two surgical methods. Using the criterion of a residual kidney stone diameter less than 4 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% confidence interval (CI): 0.56-2.28, odds ratio (OR) = 1.13, P = .724; the SFRs at 1 month postoperatively were compared: 95% CI: 0.417-2.60, OR = 1.041, P = .931. Using the criterion of a residual kidney stone diameter less than 2 mm, the SFRs at 3 days postoperatively were compared between the two groups: 95% CI: 0.355-1.055, OR = 0.612, P = .076; the SFRs at 1 month postoperatively were compared: 95% CI: 0.374-1.320, OR =.703, P = .271. There was no significant difference in the incidence of systemic inflammatory response syndrome (SIRS) and the need for postoperative analgesia between the two groups (P=0.813, P=0.839, respectively). The surgical duration in the FV-UAS group was significantly longer (P<0.001). The decrease in postoperative hemoglobin(Hb) levels and hospital stay in the FV-UAS group were significantly lower than those in the T-PCNL group (P<0.001).

Conclusion: For treating 2-3 cm renal calculi, both FV-UAS with disposable ureteroscope and 16F tubeless PCNL yield high stone-free rates. FV-UAS-assisted FURS reduces bleeding and hospital stay, whereas 16F tubeless PCNL shortens surgery duration.