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

le ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater Review (522) Total Article Views Authors: Akar EC, Knudsen BE Published Date January 2013 Volume 2013:6 Pages 1 - 10 DOI: http://dx.doi.org/10.2147/RMI.S28852 Received: 26 August 2012 Accepted: 11 December 2012 Published: 18 January 2013 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.