World journal of urology · 2026
Preoperative JJ stenting vs. percutaneous nephrostomy vs. primary flexible ureteroscopy in patients with proximal ureteral stones: a RIRSearch study with case-control matching.
СтатьяСравнительное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Şahin Mehmet Fatih, Sıddıkoğlu Duygu, Tuna Mustafa Bilal, Teke Kerem, Şimşekoğlu Muhammet Fatih, Akgül Murat, Çınar Önder, Başataç Cem, Çakır Hakan, Özman Oktay, Yazıcı Cenk Murat, Sancak Eyüp Burak, Başeskioğlu Barbaros, Önal Bülent, Akpınar Haluk
Аннотация
PURPOSE: This study aimed to compare the efficacy and safety of three treatment approaches-primary flexible ureteroscopy (fURS), preoperative double-J (JJ) stenting, and percutaneous nephrostomy (PCN)-in patients with single proximal ureteral stones, including those with varying degrees of preoperative hydronephrosis.
METHODS: We conducted a retrospective analysis of the data from the multicentric RIRSearch group (April 2017-September 2024). Patients with a single proximal ureteral stone were categorized into three groups: preoperative PCN (Group 1), preoperative JJ stent (Group 2), and primary surgery (Group 3). We conducted a case-control matching analysis to equalize the properties and ensure comparability between the groups in terms of age, stone volume, and preoperative hydronephrosis. The primary outcomes included stone free rate (SFR), surgical duration, length of hospitalization, and perioperative/postoperative complications, including fever and urinary tract infections (UTI).
RESULTS: Initially, 551 patients were included. After case-control matching, the analysis included 42, 75, and 80 patients in Groups 1, 2, and 3, respectively. No significant differences were detected in SFR (76.2%, 84.0%, 78.5%; p = 0.536) or postoperative fever/UTI rates (11.9%, 8.0%, 3.8%; p = 0.232). The operative duration was significantly longer in the preoperative PCN group (74.2 ± 28.1 min) compared with the JJ stent (56.9 ± 23.1 min) and primary fURS groups (61.0 ± 25.8 min) (p = 0.002).
CONCLUSION: For single proximal ureteral calculi, primary fURS, preoperative JJ stenting, and preoperative PCN exhibit similar efficacy and safety in terms of SFR and postoperative complications, including UTI and fever. Although PCN provides effective drainage, it may extend surgery. Personalized therapy selection and prospective randomized trials are needed to optimize management approaches.
METHODS: We conducted a retrospective analysis of the data from the multicentric RIRSearch group (April 2017-September 2024). Patients with a single proximal ureteral stone were categorized into three groups: preoperative PCN (Group 1), preoperative JJ stent (Group 2), and primary surgery (Group 3). We conducted a case-control matching analysis to equalize the properties and ensure comparability between the groups in terms of age, stone volume, and preoperative hydronephrosis. The primary outcomes included stone free rate (SFR), surgical duration, length of hospitalization, and perioperative/postoperative complications, including fever and urinary tract infections (UTI).
RESULTS: Initially, 551 patients were included. After case-control matching, the analysis included 42, 75, and 80 patients in Groups 1, 2, and 3, respectively. No significant differences were detected in SFR (76.2%, 84.0%, 78.5%; p = 0.536) or postoperative fever/UTI rates (11.9%, 8.0%, 3.8%; p = 0.232). The operative duration was significantly longer in the preoperative PCN group (74.2 ± 28.1 min) compared with the JJ stent (56.9 ± 23.1 min) and primary fURS groups (61.0 ± 25.8 min) (p = 0.002).
CONCLUSION: For single proximal ureteral calculi, primary fURS, preoperative JJ stenting, and preoperative PCN exhibit similar efficacy and safety in terms of SFR and postoperative complications, including UTI and fever. Although PCN provides effective drainage, it may extend surgery. Personalized therapy selection and prospective randomized trials are needed to optimize management approaches.