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Purpose <p>To compare the efficacy and postoperative outcomes of three surgical approaches for renal stones &lt; 3&#xa0;cm: intelligent pressure-controlled ureteral access sheath (IPC-UAS) with flexible ureterolithotripsy (FURL), FURL alone, and percutaneous nephrolithotomy (PCNL).</p> Materials and methods <p>We retrospectively analyzed 293 patients with renal stones treated at the Affiliated Hospital of Qingdao University, Qingdao, China, (December 2023–December 2024), stratified into IPC-UAS, FURL, and PCNL groups. Inclusion required preoperative diagnosis and postoperative imaging. Primary outcomes were stone-free rate (SFR) and residual stones; secondary outcomes included operative time, postoperative hospital stay, total length of stay, postoperative WBC count, neutrophil percentage, procalcitonin (PCT), hemoglobin difference, hospitalization costs, and postoperative complications (fever, bleeding).</p> Results <p>Baseline characteristics (gender, age, modified RUSS score, preoperative creatinine, collecting system dilation, largest stone diameter, stone number, CT Hounsfield units) showed no significant intergroup differences. The main results are as follows: SFR: IPC-UAS vs. FURL vs. PCNL = 1.00 [1.00, 1.00] vs. 1.00 [0.75, 1.00] vs. 1.00 [1.00, 1.00] (<i>p</i> &lt; 0.01). Residual stones count: 0.00 [0.00, 0.00] vs. 0.00 [0.00, 1.00] vs. 0.00 [0.00, 0.00] (<i>p</i> &lt; 0.01). Furthermore, SFR: IPC-UAS vs. FURL (<i>p</i> &lt; 0.01), IPC-UAS vs. PCNL (<i>p</i> = 0.533). Residual stones count: IPC-UAS vs. FURL (<i>p</i> &lt; 0.01), IPC-UAS vs. PCNL (<i>p</i> = 0.391). IPC-UAS and FURL showed comparable operative time, postoperative hospital stay, total length of stay, postoperative WBC counts, hemoglobin difference, PCT, and hospitalization costs. However, compared to PCNL, IPC-UAS demonstrates more favorable intraoperative and postoperative outcomes in all these metrics.</p> Conclusions <p>IPC-UAS combined with FURL demonstrates superior SFR, faster recovery, and reduced patient morbidity. It is a clinically viable option for renal stones &lt; 3&#xa0;cm.</p>

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Intelligent pressure-controlled ureteral access sheath combined with flexible ureteroscopy versus flexible ureteroscopy and percutaneous nephrolithotomy for renal stones less than 3 cm in diameter: a comparative efficacy study

  • 期刊论文

  • 发表日期：

    2025年9月3日

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  • Yunduo Fan,
  • Chenyu Miao,
  • Yuanxiao Li,
  • Bin Li,
  • Shengxian Li

摘要

Purpose

To compare the efficacy and postoperative outcomes of three surgical approaches for renal stones < 3 cm: intelligent pressure-controlled ureteral access sheath (IPC-UAS) with flexible ureterolithotripsy (FURL), FURL alone, and percutaneous nephrolithotomy (PCNL).

Materials and methods

We retrospectively analyzed 293 patients with renal stones treated at the Affiliated Hospital of Qingdao University, Qingdao, China, (December 2023–December 2024), stratified into IPC-UAS, FURL, and PCNL groups. Inclusion required preoperative diagnosis and postoperative imaging. Primary outcomes were stone-free rate (SFR) and residual stones; secondary outcomes included operative time, postoperative hospital stay, total length of stay, postoperative WBC count, neutrophil percentage, procalcitonin (PCT), hemoglobin difference, hospitalization costs, and postoperative complications (fever, bleeding).

Results

Baseline characteristics (gender, age, modified RUSS score, preoperative creatinine, collecting system dilation, largest stone diameter, stone number, CT Hounsfield units) showed no significant intergroup differences. The main results are as follows: SFR: IPC-UAS vs. FURL vs. PCNL = 1.00 [1.00, 1.00] vs. 1.00 [0.75, 1.00] vs. 1.00 [1.00, 1.00] (p < 0.01). Residual stones count: 0.00 [0.00, 0.00] vs. 0.00 [0.00, 1.00] vs. 0.00 [0.00, 0.00] (p < 0.01). Furthermore, SFR: IPC-UAS vs. FURL (p < 0.01), IPC-UAS vs. PCNL (p = 0.533). Residual stones count: IPC-UAS vs. FURL (p < 0.01), IPC-UAS vs. PCNL (p = 0.391). IPC-UAS and FURL showed comparable operative time, postoperative hospital stay, total length of stay, postoperative WBC counts, hemoglobin difference, PCT, and hospitalization costs. However, compared to PCNL, IPC-UAS demonstrates more favorable intraoperative and postoperative outcomes in all these metrics.

Conclusions

IPC-UAS combined with FURL demonstrates superior SFR, faster recovery, and reduced patient morbidity. It is a clinically viable option for renal stones < 3 cm.