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Purpose <p>This study aimed to compare the efficacy and safety of three treatment approaches—primary flexible ureteroscopy (fURS), preoperative double-J (JJ) stenting, and percutaneous nephrostomy (PCN)—in patients with single proximal ureteral stones, including those with varying degrees of preoperative hydronephrosis.</p> Methods <p>We conducted a retrospective analysis of the data from the multicentric RIRSearch group (April 2017–September 2024). Patients with a single proximal ureteral stone were categorized into three groups: preoperative PCN (Group 1), preoperative JJ stent (Group 2), and primary surgery (Group 3). We conducted a case–control matching analysis to equalize the properties and ensure comparability between the groups in terms of age, stone volume, and preoperative hydronephrosis. The primary outcomes included stone free rate (SFR), surgical duration, length of hospitalization, and perioperative/postoperative complications, including fever and urinary tract infections (UTI).</p> Results <p>Initially, 551 patients were included. After case-control matching, the analysis included 42, 75, and 80 patients in Groups 1, 2, and 3, respectively. No significant differences were detected in SFR (76.2%, 84.0%, 78.5%; <i>p</i> = 0.536) or postoperative fever/UTI rates (11.9%, 8.0%, 3.8%; <i>p</i> = 0.232). The operative duration was significantly longer in the preoperative PCN group (74.2 ± 28.1&#xa0;min) compared with the JJ stent (56.9 ± 23.1&#xa0;min) and primary fURS groups (61.0 ± 25.8&#xa0;min) (<i>p</i> = <b>0.002</b>).</p> Conclusion <p>For single proximal ureteral calculi, primary fURS, preoperative JJ stenting, and preoperative PCN exhibit similar efficacy and safety in terms of SFR and postoperative complications, including UTI and fever. Although PCN provides effective drainage, it may extend surgery. Personalized therapy selection and prospective randomized trials are needed to optimize management approaches.</p>

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Preoperative JJ stenting vs. percutaneous nephrostomy vs. primary flexible ureteroscopy in patients with proximal ureteral stones: a RIRSearch study with case−control matching

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Mehmet Fatih Şahin,
  • Duygu Sıddıkoğlu,
  • Mustafa Bilal Tuna,
  • Kerem Teke,
  • Muhammet Fatih Şimşekoğlu,
  • Murat Akgül,
  • Önder Çınar,
  • Cem Başataç,
  • Hakan Çakır,
  • Oktay Özman,
  • Cenk Murat Yazıcı,
  • Eyüp Burak Sancak,
  • Barbaros Başeskioğlu,
  • Bülent Önal,
  • Haluk Akpınar

摘要

Purpose

This study aimed to compare the efficacy and safety of three treatment approaches—primary flexible ureteroscopy (fURS), preoperative double-J (JJ) stenting, and percutaneous nephrostomy (PCN)—in patients with single proximal ureteral stones, including those with varying degrees of preoperative hydronephrosis.

Methods

We conducted a retrospective analysis of the data from the multicentric RIRSearch group (April 2017–September 2024). Patients with a single proximal ureteral stone were categorized into three groups: preoperative PCN (Group 1), preoperative JJ stent (Group 2), and primary surgery (Group 3). We conducted a case–control matching analysis to equalize the properties and ensure comparability between the groups in terms of age, stone volume, and preoperative hydronephrosis. The primary outcomes included stone free rate (SFR), surgical duration, length of hospitalization, and perioperative/postoperative complications, including fever and urinary tract infections (UTI).

Results

Initially, 551 patients were included. After case-control matching, the analysis included 42, 75, and 80 patients in Groups 1, 2, and 3, respectively. No significant differences were detected in SFR (76.2%, 84.0%, 78.5%; p = 0.536) or postoperative fever/UTI rates (11.9%, 8.0%, 3.8%; p = 0.232). The operative duration was significantly longer in the preoperative PCN group (74.2 ± 28.1 min) compared with the JJ stent (56.9 ± 23.1 min) and primary fURS groups (61.0 ± 25.8 min) (p = 0.002).

Conclusion

For single proximal ureteral calculi, primary fURS, preoperative JJ stenting, and preoperative PCN exhibit similar efficacy and safety in terms of SFR and postoperative complications, including UTI and fever. Although PCN provides effective drainage, it may extend surgery. Personalized therapy selection and prospective randomized trials are needed to optimize management approaches.