Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2024; 12(21): 4483-4490
Published online Jul 26, 2024. doi: 10.12998/wjcc.v12.i21.4483
Clinical efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for large kidney stones: A retrospective comparative study
Qiu-Lian Wang, Jun-Qiang Liu, Juan Cao, Jun Ding
Qiu-Lian Wang, Jun-Qiang Liu, Juan Cao, Jun Ding, Department of Urology, No. 904 Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
Author contributions: Ding J was responsible for conceptualization, methodology, resources, writing the original draft, reviewing, and editing; Wang QL was responsible for investigation, formal analysis, writing the original draft, reviewing and editing, and supervision; Liu JQ was responsible for investigation, supervision, and writing; Cao J was responsible for investigation, supervision, resources, and writing; All authors read and approved the final manuscript; Ding J, Wang QL, Liu JQ, and Cao J confirm the authenticity of all raw data.
Institutional review board statement: The study protocol was approved by the Clinical Research Ethics Committees of Wuxi Taihu Hospital (Approval Number THH-YXLL-2021-0103).
Informed consent statement: Before enrollment in the study, all participants (or their legal representatives) provided written informed consent.
Conflict-of-interest statement: All researchers state that there are no conflicting interests in this investigation.
Data sharing statement: The datasets utilized and examined in this research can be obtained upon reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun Ding, MM, Surgeon, Department of Urology, No. 904 Hospital of Joint Logistic Support Force of PLA, No. 101 Xingyuan North Road, Wuxi 214044, Jiangsu Province, China. dingjun904@21cn.com
Received: March 1, 2024
Revised: May 10, 2024
Accepted: May 28, 2024
Published online: July 26, 2024
Processing time: 121 Days and 0.8 Hours
Abstract
BACKGROUND

Renal stones ranging 20–40 mm are very common in China. Although no large-sample clinical studies have confirmed the clinical efficacy and safety of this method, there is also a lack of comparative data with traditional treatment.

AIM

To investigate the clinical efficacy of flexible ureteroscopy (FURS) and percutaneous nephrolithotomy (PCNL) by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1 (sVCAM-1) and kidney injury molecule 1 (KIM-1) levels in patients with large kidney stones (> 2 cm in diameter).

METHODS

This single-center observational study was performed at a Chinese hospital between January 1, 2021, and October 30, 2023. All 250 enrolled patients were diagnosed with large kidney stones (> 2 cm) and divided into a FURS group (n = 145) and a PCNL group (n = 105) by the surgical method. The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy. The operation time, time to palinesthesia, intraoperative blood loss, drop in hemoglobin, length of hospital stay, stone clearance rate, and complications were recorded in the two groups. Preoperative and postoperative serum sVCAM-1 levels, erythrocyte sedimentation rate (ESR), urine KIM-1 levels, preoperative and postoperative pain visual analog scale (VAS) and Wisconsin quality of life questionnaire (WISQOL) scores were also documented.

RESULTS

All 250 eligible patients completed the follow-up. There were no significant differences in baseline characteristics between the two groups (P > 0.05). The operation time in the FURS group was significantly greater than that in the PCNL group. The time to ambulation, intraoperative blood loss, decrease in hemoglobin, and length of hospital stay were significantly lower in the FURS group than in the PCNL group. The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications. There was no significant difference in antibiotic use between the groups. Postoperative serum sVCAM-1 levels, urine KIM-1 levels, and VAS scores were lower in the FURS group than in the PCNL group, but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group.

CONCLUSION

FURS demonstrated superior clinical efficacy in treating large kidney stones (> 2 cm in diameter) compared PCNL. It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1, ESR, and urine KIM-1 levels, subsequent improvement of patient quality of life.

Keywords: Kidney stones, Flexible ureteroscopy, Percutaneous nephrolithotomy, Clinical effective, SCM-1, Erythrocyte sedimentation rate, Kidney injury molecule 1

Core Tip: Our large-sample clinical study aimed to explore the clinical effectiveness of flexible ureteroscopy and percutaneous nephrolithotomy for postoperative stone clearance and managing the levels of soluble vascular cell adhesion molecule 1 and kidney injury molecule 1 in patients with large kidney stones exceeding 2 cm in diameter.