Systematic Review Comparing Flexible Ureteroscopy and Percutaneous Nephrolithotomy for Lower Pole Stone

Abstract

Background: Lower pole renal stone treatment is remains controversial, and choosing the appropriate treatment modality has become a challengeObjective: To systematically assess the effectiveness and safety of retrograde flexible ureteroscopy (FURS) versus percutaneous nephrolithotomy (PCNL) in treating lower pole stones.Methods : A search of PubMed, Cochrane Library, ScienceDirect, Wiley Online Library, and Scopus databases to identify all studies comparing FURS and PCNL for lower pole renal stones until August 2022 was conducted. Article selection was performed through the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Result: A total of 10 comparative studies involving 1241 participants with lower pole calyx stone size 1.0 – 3.0 cm were included for this systematic review. Our review found out that stone free rate PCNL procedure range around 83.3% - 98.3% and FURS procedure range around 78.6% - 93.2%; operative time of PCNL procedure range around 46.2 + 24.3 to 85.5 + 41.1 minutes meanwhile FURS procedure range around 55.8 + 11.4 to 123.0 + 57.4 minutes; hospital stay of PCNL procedure range around 0.3 + 0.04 to 5.3 + 1.20 days and hospital stay of FURS procedure range around 0.16 + 0.04 to 3.2 + 0.52 days; and complications rate after PCNL procedure range around 4.4% - 25% and after FURS procedure range around 4.6% - 21.6%.Conclusion: Most of studies shown that PCNL procedure have higher stone free rate, shorter operative time, longer hospital stays and higher complications rate compared against FURS procedure.