Comparative Study Of Flexible Ureteroscopy And Percutaneous Nephrolithotomy For Renal Calculi Of More Than 2cm In Diameter

Objective:To evaluate the efficacy of Flexible ureteroscopy lithotripsy and percutaneous nephrolithotomy lithotripsy for the renal calculi of more than 2 or equal in diameter.Methods:In the retrospective study,from March 2014 to March 2015,47 patients with renal calcuil of more than 2 or equal in diameter underwent operation which is conducted by the same operative team.Among them, 15 patients were treated with digital flexible ureteroscopy combined with holmiun laser lithotripsy(FURL group),32 patients were treated with percutaneous nephrolithotripsy(PCNL group).Comparing the completion rate of operation,operation time,postoperative complications rate,postoperative hospitalization,and calculi-free rate between both groups.Results:The operative completion rate of FURL group was 100%(15/15).The operative time was 60~300min and average time was 137.8 minutes.There was one suffered from fever(T>37.5℃),considering about the result of routine urine and germiculture,diagnosed urinary tract infection and being treated with antibiotics for 14 days.After the therapy,the fever was under control and the result of germiculture was normal(ClavienⅡ).The complication rate was 6.7%(1/15).The time from operation to leave hospital was from 1~14days and average time was 4days.The calculi-free rate was 80.0%(12/15).There was one had to terminate for bleeding too much and placed a fistula for hemostasis by ballon compression so as to undergo two stage operation after in PCNL group.The operative success rate was 96.8%(31/32).The operative time was 60~135min and average time was 82.7 minutes.There were 10 patients suffered from fever(T>37.5℃),considering about the result of routine urine and germiculture,diagnosed urinary tract infection and being treated with antibiotics for 7~14 days.After the therapy,the fever was under control and the result of and germiculture was normal(ClavienⅡ).One suffered from secondary bleeding after PCNL whose hemoglobin was as little as 65g/l and recovered after undergoing blood transfusion(ClavienⅡ).Another one had to undergo superselective renal artery embolization for his uncontrollable bleeding(hemoglobin was as little as 60g/l.(ClavienⅢ).The complication rate was 38.7%(12/31).The time from operation to leave hospital was from3~15days and average time was 7days.The calculi-free rate was 90.3%(28/31).In statistics,there was no significant difference in operative success rate,operation time,calculi-free rate(P>0.05).But significant difference existed in operative complications rate,postoperative hospitalization time.(P<0.05)Conclusion:PCNL is the first recommendation when dealing the renal calculi of more than 2cm in diameter.At the same time FURL can be another suitable choice for skillful and experienced operators.