Effect of minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in treatment of patients with upper urinary tract calculi

Objective To observe the effect of minimally invasive percutaneous nephrolithotomy (MPCNL) combined with flexible ureteroscopic lithotripsy (FURSL) in treating upper urinary tract calculi.

Methods A total of 92 patients with upper urinary tract calculi were randomly divided into two groups, with 46 cases in each group. Control group was treated with MPCNL, while study group was treated with MPCNL and FURSL. Stone clearance rate, operation time, hospital stay, therapeutic costs, renal function indexes, hemodynamics, levels of oxidative stress factors, and incidence of complications were compared between two groups.

Results The stone clearance rate, operation time and therapeutic costs of the study group were significantly higher and longer than those of the control group, while the hospital stay was significantly shorter than that of the control group (P < 0.05). At 24 hours after operation, the levels of blood urea nitrogen, serum creatinine and β₂-microglobulin in both groups were significantly higher than those before surgery (P < 0.05). There were no significant differences in central venous pressure, mean arterial pressure and heart rate at the end of operation between the two groups (P > 0.05). At 24 hours after operation, the levels of hemeoxygenase-1, endothelin-1, cortisol and angiopoietin Ⅱ in both groups were significantly higher than those before surgery, while the levels of hemeoxygenase-1, endothelin-1, cortisol and angiopoietin Ⅱ in the study group were significantly lower than those in the control group (P < 0.05). The total incidence of complications was 28.26% in the study group, which showed no significant difference compared to 23.91% in the control group (P > 0.05).

Conclusion MPCNL combined with FURSL can prolong the operation time and increase therapeutic costs, but also can increase the stone clearance rate of upper urinary tract calculi, shorten hospital stay, exert little impacts on hemodynamics and oxidative stress factors, and do not exacerbate renal function damage or increase postoperative incidence of complications.