Flexible Ureteroscopy Versus Minipercutaneous Nephrolithotomy for 2 to 4 cm Renal Stones: A Systematic Review and Meta-Analysis.
Mohab Alsaid Saad, Aya M Nasr, Tasbih Fawzi Keshk et al.
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In 30 seconds
This systematic review and meta-analysis compared flexible ureteroscopy (FURS) with mini-percutaneous nephrolithotomy (mPCNL) for 2 to 4 cm renal stones in adults. It included 20 randomized and observational studies involving 2326 patients. Pooled stone-free rates did not differ significantly between procedures (MD = 0.98, 95% CI [0.95; 1.01], p < 0.1330). FURS was associated with shorter hospital stays, less hemoglobin drop, fewer transfusions, and fewer overall complications, suggesting similar efficacy with lower measured morbidity.
Key findings
- Stone-free rates were not significantly different between FURS and mPCNL (MD = 0.98, 95% CI [0.95; 1.01], p < 0.1330).
- FURS was associated with shorter hospital stays (MD = -57.10, 95% CI [-84.10; -30.11], p < 0.0001).
- FURS was associated with fewer overall complications (risk ratio = 0.52, 95% CI [0.41; 0.65], p < 0.0001).
- FURS was associated with reduced hemoglobin drop and transfusion rates (MD = -0.75, 95% CI [-1.42; -0.07], p = 0.03; RD -0.02, 95% CI [-0.03; -0.01], p = 0.0013).
Why it matters
For renal stones measuring 2 to 4 cm, the pooled evidence suggests that FURS may achieve stone-free outcomes comparable to mPCNL while being associated with less perioperative morbidity and shorter hospitalization. These trade-offs can inform discussion of procedural options, while the inclusion of both randomized and observational studies means the findings should be interpreted in light of the underlying evidence.
What to keep in mind
The review combined randomized controlled trials and observational studies; the abstract does not report study-level quality or follow-up details.