Efficacy Analysis of Combined Dual-Endoscopic Lithotripsy via Natural Orifice for Upper Ureteral and Renal Pelvic Calculi Less than 3 cm
Chen Su
Xiang Xiaolong
Hu Xiaohui
Hu Yude
Abstract：Objective:To compare the efficacy of dual-endoscopic lithotripsy(modular ureteroscope with nega-tive pressure combined with flexible ureteroscopy)versus minimally invasive percutaneous nephrolithotomy(mPCNL)for upper ureteral and renal pelvis calculi<3.0 cm.Methods:A retrospective analysis was conducted on 746 patients with unilateral upper ureteral and renal pelvis calculi(<3.0 cm)treated at Enshi Tujia and Miao Autono-mous Prefecture Central Hospital(January 2018 to April 2024).Diagnosis was confirmed by preoperative CT urogra-phy or intravenous pyelography,with stone longest axis<3 cm.Patients were divided into dual-endoscopy(n=385)and mPCNL groups(n=361).Outcomes included operative time,intraoperative blood loss,postoperative hospital-ization,cost,the difference between preoperative and postoperative serum creatinine secondary surgery rate,stone-free rate(SFR),day-1 postoperative WBC/CRP,analgesic requirement,fever incidence,transfusion rate,renal ar-tery embolization,deep vein thrombosis(DVT),and overall complications.Results:The dual-endoscopy group demonstrated significantly lower intraoperative blood loss,shorter hospitalization,reduced the difference between pre-operative and postoperative serum creatinine lower cost,and decreased renal artery embolization(all P<0.05).How-ever,longer operative time and higher secondary surgery rates were observed versus mPCNL(P<0.05).Total SFR showed no significant difference(P>0.05).No intergroup differences existed in day-1 WBC/CRP,fever incidence,or DVT(P>0.05).The dual-endoscopy group had lower analgesic requirements,transfusion rates,and overall com-plications(P<0.05).Conclusion:Dual-endoscopic lithotripsy via natural orifices for upper ureteral and renal pelvis calculi(<3.0 cm)achieves high stone clearance with advantages of reduced bleeding,faster recovery,and fewer complications,representing a promising clinical alternative.
Keywords：natural orificedual-endoscopic combinationminimally invasive percutaneous nephrolithotomyupper ure-teral stonerenal pelvis stone
Publication Date：2025-06-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 155-160 )