Volume 13, Supplement 1
Original Article / Published: April 2025
DOI: https://www.doi.org/10.57045/jemis/1310425.pp20-21
O. Gatsev , V. Todorova , K. Hristov , K. Petkova , D. Petrova, I. Saltirov
Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
Abstract
Introduction: The management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter and other factors which impede stone access, visibility and lithotripsy and can lead to different types of complications. The objective of our study is to compare the efficacy and safety of minimally invasive percutaneous nephrolithotripsy (mini-PNL) and retrograde intrarenal surgery (RIRS) with FANS in the treatment of impacted proximal ureteral stones.
Materials and methods: The medical records of 94 patients with impacted proximal ureteral stones 10-15 mm, treated between January 2020 – December 2024, were retrospectively reviewed. 43 patients (45.7%) underwent mini-PNL, and 51 (54.3%) – RIRS with FANS. Data on patients’ preoperative characteristics, stone-free rates, operating times, intra- and postoperative complications were compared.
Findings: Patients’ preoperative characteristics were comparable between the two groups, except for preoperative level of Hemoglobin and Stone Density (HU), which were significantly higher in the mini-PNL group (respectively, 147,3 ± 14,2g/l vs 127,4 ± 14,7 g/l, p=0.000; and 1151,9±170,8vs 1060,4±70,3, p=0.001). The stone-free rate after single procedure was 93.0% for mini-PNL and 86,3% in the RIRS group (p=0,335). One patient (2.3%) in the mini-PNL group had a significant hemorrhage necessitating selective renovasography and angioembolization of AV fistula and additional hemotransfusion. 3 (5,9%) patients had fever > 38,5oC postoperatively in RIRS group. Mean operative time was significantly longer in the RIRS group, despite the smaller size of the stones (respectively, 42,2±4,6min vs. 24,6±7,4min, p=0,000). There were statistically significant difference of the necessity of auxiliry procedures in the RIRS group (respectively, 34 patients (68,5%) vs 9 patients (20,8%), p=0.000).
Conclusions: Both RIRS with FANS and mini-PCNL are effective for managing proximal ureteral stones. Mini-PNL had better stone-free rates, shorter operative time and low percentage of auxiliary procedures and hospitalizations. However, fURS with FANS had the advantages of a less invasive procedure and shorter postoperative hospital stay. Personalized treatment planning, taking into account patient and stone characteristics, is essential to optimize outcomes.
References
Keywords:
Minimally invasive percutaneous nephrolithotomy, retrograde intrarenal surgery, proximal impacted stone, FANS
How to cite this article:
O. Gatsev , V. Todorova , K. Hristov , K. Petkova , D. Petrova, I. Saltirov. Comparison of minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery with flexible and navigable suction ureteral access sheath (FANS) in the management of impacted proximal ureteral stones. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 20-21
Corresponding author:
Dr. Ognyan Gatsev
Address: Military Medical Academy, Sofia, Department of Urology and Nephrology “Georgi Sofiiski” Blvd. 3, 1606
Email: gatsev@gmail.com