PERCUTANEOUS NEPHROLITHOTOMY VERSUS FLEXIBLE URETEROSCOPY IN MANAGEMENT OF RENAL STONES

Abstract

SUMMARY P NL is the first line of treatment of renal stones >2cm according to EUA guidelines. PNL has minor complications and a high stone free rate. With advancement of flexible ureteroscopy, it becomes an option for treating renal stones with minimal complications and low hospital stay. The aim of this work was to evaluate the efficacy and safety of both PNL and flexible ureteroscopy in treatment of renal stones. To achieve this goal, this study was done over 30 patients with renal stones > 2cm in size. It was a double armed clinical trial with 15 patients in each arm. Patients in Group A were treated by PNL. While patients in group B were treated by flexible ureteroscopy. Stone free rate was 80% in group A while it was 86 % in group B. 6.7 % of patients in group A developed severe bleeding that required blood transfusion while 0 % had in group B 33.3 % of patient in group A had post operative fever, while only 13.3 % of patients had post operative fever in group B. Mean operative time was 96 +/- 28.23 min in group A while it was 120 +/- 25.36 min in group B Mean hospital stay was 84 +/- 40.82 hrs in group A while it was 30.40 +/- 14.25 hrs in group B 100 % of patients in group A required post operative analgesics while only 6.7 % of patients required analgesics in group b. Mean cost in group A was 2075 +/-50 pound while mean cost in group b was 9313 +/- 66 pound. PNL remains the gold standard option for treatment of renal stones > 2cm with low incidence of complications. Flexible ureteroscopy is an acceptable alternative in management of renal stones especially in patients with comorbidities. Flexible ureteroscopy costs too much higher than PNL.