Flexible ureteroscopy with lithotripsy using suction technology achieved stone-free rates comparable to miniaturized percutaneous nephrolithotomy in patients with 2 to 3 cm renal stones, according to a review published in Research and Reports in Urology.

In a multicenter randomized noninferiority trial cited in the review, immediate stone-free rates (SFRs) were 84% with flexible ureteroscopy with lithotripsy (FURL)  and 85% with miniaturized percutaneous nephrolithotomy (mini-PCNL), with rates of 90% and 92%, respectively, at 3 months. Other comparative studies reported no statistically significant differences in SFR at early and short-term follow-up, although some studies suggested that mini-PCNL may have an advantage in immediate SFR.

Advances in flexible negative-pressure suction sheaths and intrarenal pressure-control systems have expanded the role of FURL in moderate stone burdens. These technologies enable simultaneous fragment extraction and real-time regulation of intrarenal pelvic pressure, addressing limitations of conventional ureteroscopy related to residual fragments and elevated pressure.

Across studies summarized in the review, suction-assisted FURL was associated with lower intrarenal pressure, shorter hospital stay, and lower postoperative pain compared with mini-PCNL. By maintaining lower intrarenal pressure, suction systems may also help reduce the risk of infectious complications. In the randomized trial, patients treated with FURL had improved quality of life. The authors also reported favorable safety profiles with suction-assisted FURL in pediatric and anatomically complex populations.

Extracorporeal shock wave lithotripsy remains a noninvasive option for smaller stones but is generally not recommended as a standalone treatment for stones larger than 2 cm.

Percutaneous nephrolithotomy remains the gold standard for large stone burdens, particularly those greater than 2 cm. However, the 2 to 3 cm range is increasingly being challenged by suction-assisted FURL, with comparative studies suggesting similar stone-free outcomes.

The researchers emphasized that treatment selection should be individualized based on stone characteristics, patient factors, and available expertise. They also noted that additional multicenter, large-scale trials are needed to further define the role of suction-assisted FURL in larger stones.

The researchers reported no conflicts of interest.

Source: Research and Reports in Urology