Abstract
OBJECTIVE: To evaluate the efficacy of flexible ureteroscopy with stone fragmentation (FURS) combined with suction sheath versus percutaneous nephrolithotomy (PCNL) for treating staghorn calculi. METHODS: This retrospective study analyzed 80 patients with staghorn calculi treated between January 2021 and December 2024. Patients were categorized into the PCNL group (n = 38) and the FURS with suction sheath group (n = 42) based on the surgical procedure performed. These group labels are used consistently throughout the manuscript. We compared the following parameters between groups: baseline characteristics, perioperative indicators (operative time, intraoperative blood loss, hospital stay, postoperative hemoglobin decrease, lithotripsy time, hospitalization costs), renal function and inflammatory markers (BUN, Scr, CRP, PCT), quality of life scores, stone clearance rates, and postoperative complications. RESULTS: The FURS with suction sheath group demonstrated significantly lower intraoperative blood loss, shorter hospitalization duration, reduced postoperative hemoglobin decline, and shorter lithotripsy time compared to the PCNL group (P < 0.05). However, the FURS with suction sheath group had a longer total operative time than the PCNL group (72.63 ± 8.47 min vs. 68.21 ± 8.67 min, P < 0.05), despite a shorter lithotripsy time (47.26 ± 6.50 min vs. 56.67 ± 8.20 min, P < 0.001). This apparent discrepancy can be explained by the additional time required in the FURS group for complex retrograde access, careful placement of the suction sheath under guidance, and the meticulous process of laser fragmentation combined with continuous suction in the complex collecting system of staghorn stones. In contrast, PCNL, once percutaneous access is established, allows for more rapid bulk lithotripsy and fragment removal. Postoperatively, the FURS with suction sheath group exhibited significantly lower levels of BUN, Scr, CRP, and PCT compared to the PCNL group (P < 0.05). Additionally, the FURS with suction sheath group demonstrated significantly higher scores in physical function, physical role function, social function, and mental health compared to the PCNL group (P < 0.05). The superior stone clearance in the FURS group (92.86%) may be attributed to the combined effect of laser fragmentation and continuous suction, which allowed thorough clearance of fragments from multiple calyces without the access limitations of percutaneous tracts. The stone clearance rate in the FURS with suction sheath group (92.86% vs. 76.32%) was higher than that in the PCNL group, and the overall postoperative complication rate (4.76% vs. 21.05%) was lower than that in the PCNL group, with statistically significant differences (P < 0.05). This relatively lower rate compared to some literature reports may be attributed to the complexity of staghorn stones, including extensive calyceal involvement and branching patterns that challenged complete clearance through a limited number of tracts. CONCLUSION: For treating patients with staghorn calculi, PCNL offers shorter procedure times and lower costs. However, FURS combined with suction sheaths reduces lithotripsy duration and hospitalization time, decreases intraoperative blood loss, improves stone clearance rates, lowers postoperative complication rates, and mitigates renal function impairment and inflammatory responses.