ObjectiveTo compare the safety and efficacy of flexible ureteroscopy (f‐URS) and ambulatory tubeless mini‐percutaneous nephrolithotomy (mini‐PCNL) in the treatment of 1–2 cm lower calyceal renal stones.Patients and MethodsPatients who underwent f‐URS and mini‐PCNL for the treatment of 1–2 cm lower calyceal renal stones between October 2020 and November 2023 were evaluated in a randomised controlled trial. A total of 72 patients were included in the study. All patients underwent a computed tomography renal colic scan preoperatively, on postoperative Day 1 (POD 1), and at 3 months follow‐up. We compared perioperative outcomes, including operative time and hospital stay. Additionally, we evaluated follow‐up outcomes, such as the stone‐free rate (SFR) and complications. All patients were discharged home on the same operative day.ResultsThere were no significant differences in preoperative baseline data between the two surgical groups. A significantly longer median operative time was reported in the mini‐PCNL group (P = 0.04). The median hospital stay was 5 h and 4 h in the mini‐PCNL and f‐URS groups, respectively (P = 0.14). On POD 1, the SFR, defined as the absence of residual fragments measuring 0 cm, was 50% for mini‐PCNL vs 11.1% for f‐URS (P < 0.001). When a total cut‐off of <4 cm was utilised, the SFR was 75% in the mini‐PCNL group vs 22.2% in the f‐URS cohort (P < 0.001). At 3 months follow‐up, the SFR remained favourable for mini‐PCNL at 72.2% vs 37.1% for f‐URS (P = 0.003), with a cut‐off of 0 cm, and it increased to 86.1% for mini‐PCNL vs 65.7% for f‐URS (P = 0.04) when a total cut‐off of <4 cm was applied. There was no significant difference in postoperative complications between the two groups. Two patients (5.7%) in the f‐URS group required re‐treatment.ConclusionsAmbulatory tubeless mini‐PCNL and f‐URS are effective treatment options for 1–2 cm lower calyceal renal stones. Both techniques have a comparable hospital stay and complication rates, with a significantly better SFR with mini‐PCNL.

中文翻译：

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小经皮肾镜取石术与输尿管软镜治疗 1-2 cm 下极肾结石的比较：一项随机对照试验


目的比较输尿管软镜 （f-URS） 和非卧床无管微型经皮肾镜取石术 （mini-PCNL） 治疗 1-2 cm 下肾盏肾结石的安全性和有效性。患者和方法在一项随机对照试验中评估了 2020 年 10 月至 2023 年 11 月期间接受 f-URS 和 mini-PCNL 治疗 1-2 cm 下肾盏肾结石的患者。该研究共纳入 72 名患者。所有患者在术前、术后第 1 天 （POD 1） 和 3 个月随访时接受了计算机断层扫描肾绞痛扫描。我们比较了围手术期结局，包括手术时间和住院时间。此外，我们评估了随访结局，例如结石清除率 （SFR） 和并发症。所有患者均在同一手术当天出院回家。结果两组手术组术前基线资料差异无统计学意义。据报道，mini-PCNL 组的中位手术时间显着延长 （P = 0.04）。mini-PCNL 和 f-URS 组的中位住院时间分别为 5 h 和 4 h （P = 0.14）。在 POD 1 上，SFR（定义为不存在 0 cm 的残留片段）为 mini-PCNL 的 50%，而 f-URS 为 11.1% （P < 0.001）。当使用 <4 cm 的总临界值时，mini-PCNL 组的 SFR 为 75%，而 f-URS 队列为 22.2% （P < 0.001）。在 3 个月的随访中，SFR 对 mini-PCNL 仍然有利，为 72.2%，而 f-URS 为 37.1% （P = 0.003），临界值为 0 cm，当应用总临界值为 <4 cm 时，它增加到 mini-PCNL 的 86.1%，而 f-URS 的 SFR 为 65.7% （P = 0.04）。两组术后并发症差异无统计学意义。f-URS 组有 2 例患者 （5.7%） 需要再次治疗。结论动态无管 mini-PCNL 和 f-URS 是 1-2 cm 下肾盏肾结石的有效治疗选择。两种技术的住院时间和并发症发生率相当，mini-PCNL 的 SFR 明显更好。