Comparison Of Flexible Ureteroscopic Lithotripsy And Minimally Invasive Pertucaneous Nephrolithotomy For 2 To 3 Cm Pelvic Renal Calculi

Objective:To compare treatment effect and safety of Flexible Ureteroscopic Lithotripsy and minimally invasive Pertucaneous Nephrolithotomy in patients with 2-3cm pelvic renal calculi.Methods:60 patients with 2-3cm pelvic renal calculi conformed by B-ultrasound and CT were treated in urinary surgery of Second hospital of Jilin University from 2013.5-2016.7.30 patients were taken Flexible Ureteroscopic Lithotripsy treatment(FURL Group)and 30 patients were taken minimally invasive Pertucaneous Nephrolithotomy(mPCNL Group),all of them were treated by the same operator.The data of operative time,postoperative hospitalization time,amount of intraoperative bleeding,postoperative CRP rising,postoperative complications such as hyperpyrexia(body temperature > 39 ?),postoperative severe bleeding,visceral injury and urinary pyemia,the total cost of hospitalization and calculi clearance rate at 1 mouth after operation were compared.Result:Each group was successful in the first step of operation about setting flexible ureteroscope and puncturing.The data show that operative time of FURL Group was 40-110(mean77.83±20.83)min,operative time of mPCNL Group was 40-120(mean83.00±23.69)min,there was no statistic difference(p>0.05).Postoperative hospitalization time of FURL Group was 2-5(mean2.80±0.76)d,Postoperative hospitalization time of mPCNL Group was 5-8(mean6.17±0.83)d,the difference had statistic significance(p<0.05).Amount of intraoperative bleeding was 5-30(mean14.50±5.14)ml in FURL Group,Amount of intraoperative bleeding was 20-150(mean71.00±25.91)ml in mPCNL Group,the difference had statistic significance(p<0.05).Postoperative CRP rising was(5.24±2.89)ml/L in FURL Group,postoperative CRP rising was(16.28±8.00)ml/L in mPCNL Group,the difference had statistic significance(p<0.05).There was no severe postoperative complications in FURL Group,2patients had a complication of postoperative severe bleeding and 2patients had hyperpyrexia(body temperature > 39 ?,the rate of complication was 13.33% in mPCNL Group,but no visceral injury occured.FURL cost 28.41-36.78(mean32.11±2.08)thousand yuan in hospitalization,mPCNL cost 21.54-27.25(mean24.25±1.37)thousand yuan,the difference had statistic significance(p<0.05).Calculi clearance rate at 1 mouth after operation was 93.3%(28/30)and96.7%(29/30)In FURL Group and mPCNL Group,there was no statistic difference(p>0.05).Conclusions:FURL and mPCNL are both effective and safe to treat patients who have 2-3cm pelvic renal calculi,besides,there was no statistic difference in operative time nor calculi clearance rate at 1 mouth after operation.FURL is better than mPCNL in aspects of postoperative hospitalization time,amount of intraoperative bleeding,postoperative complications,but it is more expensive.For 2-3cm pelvic renal calculi,FURL is worthy of recommendation if economic factor is not in consideration.