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Inicio Actas Urológicas Españolas (English Edition) Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for th...
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Vol. 43. Issue 3.
Pages 111-117 (April 2019)
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Vol. 43. Issue 3.
Pages 111-117 (April 2019)
Review article
Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3cm renal lithiasis
Comparación entre nefrolitotomía percutánea y ureteroscopia flexible para el tratamiento de litiasis renales de entre 2 y 3cm
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Á.A. Fernández Alcalde
Corresponding author
, M. Ruiz Hernández, V. Gómez dos Santos, C. Sánchez Guerrero, D.E. Diaz Pérez, F. Arias Fúnez, I. Laso García, G. Duque Ruiz, F.J. Burgos Revilla
Departamento de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Tables (4)
Table 1. Characteristics of the studies included in the systematic review.
Table 2. Evaluation of the lithiasis-free rate and number of procedures performed.
Table 3. Surgical time, complications and length of in-hospital stay.
Table 4. Analytic variations.
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Abstract
Context and objectives

The first-line treatment for >2cm lithiasis is percutaneous nephrolithotomy (PNL), leaving flexible ureteroscopy (FURS) as a second option. In the present review, the stone-free rate and the complications of both techniques were evaluated in the treatment of 2–3cm stones.

Material and methods

Systematic review of studies that compared both techniques. Studies that were not comparative, as well as those carried out in the paediatric population or with <2cm or >3cm stones, were excluded.

Two researchers independently performed the investigation, obtaining 5 studies that made up a total of 815 patients: 252 belonged to the FURS group and 563 to the PNL group. Four studies were retrospective, and one was non-randomised prospective.

Results

Stone-free rate ranged between 47.0% and 95.0% for the FURS and between 87.0% and 100% for the PNL. The complication rate was 8.8–29.0% in the FURS and 11.9–27.0% in the PNL. FURS required a greater number of procedures, and had a lower decrease in haemoglobin and creatinine rise compared to PNL.

Conclusions

The stone-free rate was higher for PNL, although the FURS could reach comparable results at the expense of performing several procedures. Both techniques have a similar frequency of complications, but the PNL has more postsurgical analytical alterations.

Keywords:
Percutaneous nephrolithotripsy
Flexible ureterorenoscopy
Renal lithiasis 2–3cm
Resumen
Contexto y objetivos

El tratamiento de primera elección para litiasis >2cm es la nefrolitotomía percutánea (NLP), dejando a la ureteroscopia flexible (URS-F) como una segunda opción. En la presente revisión se evaluaron la tasa libre de litiasis y las complicaciones de ambas técnicas en el tratamiento de litiasis de tamaño entre 2 y 3cm.

Material y métodos

Revisión sistemática de estudios que compararon las dos técnicas. Fueron excluidos aquellos estudios que no fueran comparativos, los realizados en población pediátrica o con litiasis menores de 2cm o mayores de 3cm.

Dos investigadores realizaron independientemente la búsqueda, obteniendo 5 estudios que abarcaban un total de 815 pacientes: 252 pertenecieron al grupo de URS-F y 563 al de NLP. Cuatro fueron retrospectivos y uno fue prospectivo no aleatorizado.

Resultados

La tasa libre de litiasis osciló entre el 47,0 y el 95,0% para la URS-F y entre el 87,0 y el 100% para la NLP. La tasa de complicaciones fue del 8,8-29,0% en la URS-F y del 11,9-27,0% en la NLP. La URS-F requirió un número mayor de procedimientos y tuvo un menor descenso de hemoglobina y ascenso de creatinina en comparación con la NLP.

Conclusiones

La tasa libre de litiasis fue mayor en la NLP, aunque la URS-F podría alcanzar unos resultados comparables a expensas de realizar varios procedimientos. Ambas técnicas tienen una frecuencia de complicaciones similar, pero con más alteraciones analíticas posquirúrgicas en el grupo de NLP.

Palabras clave:
Nefrolitotomía percutánea
Ureteroscopia flexible
Litiasis renal 2-3cm

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