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Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater

Authors Akar E, Knudsen B

Received 26 August 2012

Accepted for publication 11 December 2012

Published 16 January 2013 Volume 2013:6 Pages 1—10


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Erin Akar, Bodo E Knudsen

Department of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USA

Abstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS) is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL) for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.

Keywords: ureteroscopy, percutaneous nephrolithotomy, lithotripsy, urinary calculi

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