Mini-percutaneous nephrolithotomy versus flexible ureteroscopic holmium laser lithotripsy using a negative-pressure ureteral access sheath: a minimally invasive approach for renal calculi.

INTRODUCTION

Renal calculi are a common urological condition, and minimally invasive surgical techniques have become the mainstay of treatment. We evaluated and compared the clinical effectiveness of mini-percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopic holmium laser lithotripsy (FURL) assisted by a negative-pressure ureteral access sheath (NPUAS) in the management of renal calculi.

METHODS

A total of 124 patients with renal calculi were assigned to mini-PCNL (n = 62) or NPUAS-FURL (n = 62) groups. Surgical parameters (operative time, blood loss), hospitalization, stone clearance, efficacy, complications, renal function (Scr, BUN, UA), inflammatory markers (IL-6, CRP, PCT), and postoperative pain (VAS at 4/12/24/48 h) were evaluated.

RESULTS

Compared with mini-PCNL, the NPUAS-FURL group demonstrated shorter operative and hospitalization times and reduced intraoperative bleeding (P < 0.05). Stone clearance and overall efficacy were higher in the NPUAS-FURL group (95.16% each) than in the mini-PCNL group (77.42% and 80.65%; P < 0.05). The incidence of complications was similar between groups (14.52% vs. 22.58%, P > 0.05). At 24 h postoperatively, Scr, BUN, UA, IL-6, CRP, and PCT increased in both groups but remained significantly lower in the NPUAS-FURL group (P < 0.05). VAS scores progressively decreased over time, with consistently lower values observed in the NPUAS-FURL cohort (P < 0.05).

CONCLUSION

NPUAS-assisted FURL outperforms mini-PCNL in renal calculi treatment, offering higher stone clearance, reduced trauma, better renal function preservation, milder inflammation, and less pain, with comparable safety.