Comparison Of The Efficacy Of FURL Combined With Negative Pressure Ureteral Access Sheath And PCNL In The Treatment Of Infectious Kidney Stones Over 2cm

Objective:By comparing the efficacy of flexible ureteroscopy lithotripsy(FURL)combined with negative pressure ureteral access sheath(NPUAS)and percutaneous nephrolithotripsy(PCNL)in the treatment of infectious kidney stones above 2 cm and the incidence of postoperative complications,to analyze the advantages and disadvantages of those two surgical methods and discuss the better surgical methods in the treatment of infectious kidney stones above 2 cm.Methods:A total of 152 patients who were diagnosed as infectious kidney stones after surgery in the urology department of the Second Hospital of Jilin University from January 2019 to October 2022 were retrospectively analyzed.They were divided into two groups according to the surgical methods: the flexible ureteroscopic lithotripsy combined with negative pressure ureteral access sheath group(FURL+NPUAS group)and the standard percutaneous nephroscope group(PCNL group).The age,sex,stone volume,stone location and other general preoperative conditions,postoperative complications,and stone clearance rate within 3 months after operation of the patients with 2cm～3cm and larger than 3cm who received the above two surgical methods were counted and analyzed respectively.By comparing and analyzing the advantages and disadvantages of FURL combine with NPUAS and PCNL those two surgical methods in the treatment of infectious kidney stones,to explore the choice in the treatment of infectious kidney stones above 2 cm.Results:A total of 152 patients who were diagnosed as infectious kidney stones after surgery.The operations were all completed in PCNL group.There were 4 patients in the FURL+NPUAS group who failed to insert the ureteral access sheath due to ureteral stricture.The clinical data of these 4patients were not counted and analyzed.Finally,a total of 148 patients were enrolled and their clinical data were analyzed,including 75 patients with2cm～3cm infectious kidney stones,39 patients in the FURL+NPUAS group and 36 patients in the PCNL group;There were 73 cases of infectious kidney stones above 3 cm,37 cases in the FURL+NPUAS group and 36 cases in the PCNL group.No matter the kidney stones were 2cm～3 cm or larger than 3 cm,there was no statistically significant difference in the preoperative general condition of patients in the FURL+NPUAS group and PCNL group(p>0.05).When treating infectious renal stones between 2cm to 3cm,there was no significant difference between the FURL+NPUAS group and the PCNL group in primary stone removal rate,summary stone renmoval rate,infection related complications,white blood cell count on the first day after operation,Procalcitonin(PCT)2 hours after operation,neutrophil ratio on the first day after operation,and operation time(p>0.05).The hemoglobin and hospital stay time in the FURL+NPUAS group was better than that in the PCNL group(p<0.05).When the infectious kidney stones were above 3 cm,there was no significant difference between the FURL+NPUAS group and PCNL in total stone clearance rate,infection related complications,white blood cell count on the first day after operation,and neutrophil ratio on the first day after operation(p>0.05).The primary stone clearance rate of PCNL group was higher than that of FURL+NPUAS group(p<0.05).And the procalcitonin 2 hours after operation,reoperation rate and operation time were lower than those of FURL+NPUAS group,2hours after operation the difference was statistically significant(p<0.05).Compared with PCNL group,the postoperative hospital stay in FURL+NPUAS group was shorter,and the difference is statistically significant(p<0.05).Conclusion:(1)When treating 2cm～3cm infectious kidney stones,the stone clearance rate of FURL with NPUAS is similar to that of PCNL,and FURL with NPUAS has advantages in infection-related complications,surgical bleeding,and postoperative hospital stay,which can be used as a first-line treatment to replace PCNL.(2)In the treatment of infectious kidney stones larger than 3cm,although the total stone clearance rate of FURL with NPUAS is similar to that of PCNL,the primary stone clearance rate is significantly lower than that of PCNL,and the reoperation rate is higher,so PCNL is more recommended.(3)During FURL treatment of infectious kidney stones,it is necessary to pay close attention to the drainage of irrigation fluid,keep the drainage of irrigation fluid unobstructed,strictly control the pressure in the renal pelvis,and strictly control the time of single operation,so as to minimize the complications related to postoperative infection,especially the occurrence of urogenic sepsis.