Appropriatekidneystonesizeforureteroscopiclithotripsy:Whentoswitchtoapercutaneousapproach

摘要： Flexibleureteroscopy(fURS)hasbecomeamoreeffectiveandsafertreatmentforwholeupperurinarytractstones.Percutaneousnephrolithotomy(PNL)iscurrentlythefirst-linerecommendedtreatmentforlargekidneystones≥20mmandithasanexcellentstone-freerateforlargekidneystones.However,itsinvasivenessisnotnegligibleconsideringitsmajorcomplicationrates.StagedfURSisapracticaltreatmentforsuchlargekidneystonesbecausefURShasaminimalbloodtransfusionrisk,shorthospitalizationandfewrestrictionsondailyroutines.However,asthestonesizebecomeslarger,thestone-freeratedecreases,andthenumberofoperationsrequiredincreases.Therefore,inouropinion,stagedfURSisapracticaloptionforkidneystones20to40mm.MiniaturizedPNLcombinedwithfURSshouldbeconsideredtobeapreferredoptionforstoneslargerthan40mm.Moreover,URSisaneffectivetreatmentformultipleupperurinarytractstones.Especiallyforpatientswithastoneburden<20mm,URSisafavorableoptionthatpromisesahighstone-freerateafterasinglesessioneitherunilaterallyorbilaterally.However,forpatientswithastoneburden≥20mm,astagedoperationshouldbeconsideredtoachievestone-freestatus. ... （共7頁）