Flexible ureterorenoscopy vs percutaneous nephrolithotomy for renal stone management: Retrospective study

Purpose. The aim of this study was to evaluate the efficacy and tolerance of renal stone fragmentation by flexible ureterorenoscopy (URS), compared to percutaneous nephrolithotomy (PCNL). Material and methods. Patients treated between 1998 and 2010 by URS and PCNL for intrarenal stone were reviewed. Patients' and stones' characteristics were analyzed. The preoperative parameters were reported as well as the procedure's efficiency and its complications. Success was defined by the absence of residual lithiasis visualized on renal imaging at 6 months of follow-up. Results. Among 531 patients included, there were 159 PCNL and 372 URS. The mean duration of hospitalization after PCNL was 8 4.6 days and 3 1.7 days after URS. The mean stones' size was higher in the PCNL group (19.9 7.5 mm) than for the URS group (9.7 5.6 mm; P< 0.0001). The stone-free rate was significantly better in the PCNL group for stones measuring between 10 and 20 mm (P < 0.0001) and for stones of more than 20 mm (P= 0.017). Postoperative complications were significantly more frequent (27 %) and more severe (8.8 % vs Clavien III and IV) in the PCNL, than in the URS group, respectively (P=0.0001). Conclusion. PCNL is a successful technique for renal stone fragmentation. However, URS seemed more tolerated despite a lower stone-free rate. Level of evidence. 4. (C) 2016 Elsevier Masson SAS. All rights reserved.