Comparison of flexible ureteroscopy and percutaneous nephrolithotomy for the management of 10-20-mm renal stones: A 5-year retrospective study

Comparison of laparoscopic-assisted flexible ureteroscopic lithotripsy with percutaneous nephrolithotripsy and flexible ureteroscopy lithotripsy: a case-control study and meta-analysis

BACKGROUND

This study aims to compare the differences in stone clearance rate, infection rate, and bleeding risk among laparoscopic-assisted flexible ureteroscopic lithotripsy (LAFUL), percutaneous nephrolithotripsy (PCNL), and flexible ureteroscopic lithotripsy (FUL) through case-control studies and meta-analysis, to evaluate the safety and effectiveness of LAFUL.

METHODS

1. Through systematic literature search, clinical studies related to LAFUL, PCNL, and FUL were screened, and data on stone clearance rate, infection rate, and bleeding events were collected and analyzed for three groups of patients, followed by meta-analysis. 2. Data of patients who met the single center inclusion criteria and received LAFUL (40 cases), PCNL (40 cases, FUL), and FUL (40 cases) treatments for kidney stones from January 2021 to December 2023 were collected. Using a case-control study method, relevant clinical data were analyzed using SPSS 26.0 software.

RESULTS

A total of 31 studies involving 2974 patients were included. The results of case-control analysis showed the stone clearance rate in the LAFUL group (F = 225.19, P < 0.001) and the positive rate of postoperative urine bacterial culture (X2 = 4.558, P = 0.033). The results of meta-analysis showed the stone clearance rate (rate = 0.986, 95% CI 0.964-0.999) and blood transfusion rate (rate = 0, 95% CI 0-0.012) in the LAFUL group.

CONCLUSION

LAFUL shows potential in improving the stone clearance rate and reducing the risk of postoperative infection and bleeding, suggesting it may have certain advantages in the treatment of renal calculi.

Design and Performance Investigation of a Robot-Assisted Flexible Ureteroscopy System

Flexible ureteroscopy (FURS) has been developed and has become a preferred routine procedure for both diagnosis and treatment of kidney stones and other renal diseases inside the urinary tract. The traditional manual FURS procedure is highly skill-demanding and easily brings about physical fatigue and burnout for surgeons. The improper operational ergonomics and fragile instruments also hinder its further development and patient safety enhancement. A robotic system is presented in this paper to assist the FURS procedure. The system with a master-slave configuration is designed based on the requirement analysis in manual operation. A joint-to-joint mapping strategy and several control strategies are built to realize intuitive and safe operations. Both phantom and animal experiments validate that the robot has significant advantages over manual operations, including the easy-to-use manner, reduced intraoperative time, and improved surgical ergonomics. The proposed robotic system can solve the major drawbacks of manual FURS. The test results demonstrate that the robot has great potential for clinical applications.