Comparison Of Flexible Ureteroscope Holmium Laser Lithotripsy And Tubeless Minimally Invasive Percutaneous Nephrolithotomy In The Treatment Of Renal Calculi?2cm

Objective:To compare the clinical efficacy of flexible ureteroscope lithtripsy and tubeless minimally invasive percutaneous nephrolithotomy in the treatment of renal calculi ?2.0cm.To discuss the safety and the best indication of two kinds of surgical treatment of renal calculi ? 2.0cm.Methods:A retrospective analysis was performed on 92 patients who were admitted to the urology department of the first people's hospital of jining,shandong province from April 2017 to January 2018.According to different operation method,it can be divided into two groups.43 patients with renal stone were treated with FURL group,and49 patients were treated with TMPCNL group.Compared two groups of operation time,postoperative hemoglobin(Hb)decline in value,postoperative white blood cell(WBC)increased value,postoperative fever rate and the average visual analogous scale(VAS),postoperative hospital stay,stone free rate(SFR)and complications.Results:The operation of both groups was completed successfully.Stone diameter of two groups of patients respectively FURL group(1.45 ± 0.37)cm and TMPCNL group(1.49 ± 0.30)cm,there was no statistically significant difference(P>0.05).There was no statistically significant difference in the scores of S.T.O.N.E.(P>0.05).FURL group,2 cases of postoperative fever,postoperative fever rate was 4.7%,the WBC increased average value(2.64 ± 0.93)× 109/L,the SFR ofpostoperative 1 month is 90.7%;TMPCNL group,7 cases of postoperative fever,postoperative fever rate was 14.3%,the WBC increased average value(2.59±1.07)×109/L,the SFR of postoperative 1month is 93.9%,there was no statistically significant difference between the two groups(P>0.05).FURL group average operation time was(72.09 ± 16.23)min,postoperative Hb mean drop(2.42 ± 1.52)g/L,the average of postoperative hospital stay(1.86±0.60)d,postoperative SFR 2days was 74.4%,no postoperative complications occurred;TMPCNL group average operation time was(51.84±10.59)min,postoperative Hb mean drop(13.63 ± 4.19)g/L,the average of postoperative hospital stay(3.82 ± 1.65)d,postoperative SFR 2 days was 91.8%,2 cases of postoperative complications(1 case of delayed hemorrhage and 1 case of pleural injury),and the differences between the two groups were statistically significant(P<0.05).Conclusion:The flexible ureteroscope lithtripsy and tubeless minimally invasive percutaneous nephrolithotomy is the main method for the treatment of renal calculi.For renal calculi(?2.0cm),FURL forward SFR is the same as TMPCNL,but FURL is more noninvasive,reducing the incidence of postoperative complications,less postoperative pain and shorter postoperative hospital stay,etc.FURL should be used as the first choice for treatment of renal calculi(?2.0cm).But for FURL patients,preoperative should carefully assess the size,location,CT value of stones,and the condition of renal calyx,avoid intraoperative operating difficulties,stone free rate reduced.