Abstract
The study aims to compare the efficacy of flexible ureteroscopy (FURS) with holmium laser lithotripsy (HLL, herein collectively referred to as FURS-HLL) and percutaneous nephrolithotomy (PCNL) in the treatment of complex upper urinary tract calculi in elderly patients, highlighting the advantages of FURS-HLL. A total of 40 elderly patients (aged ≥ 60) with complex upper urinary tract calculi admitted to the Department of Urology, Fuyong People's Hospital from October 2020 to October 2023 were randomly divided into 2 groups on the basis of the treatment they received: the FURS-HLL group (preset ureteral stent) and the PCNL group. The operation time, intraoperative blood loss, hospital stay, stone-free rate, and postoperative complications (fever, hematuria, infection, and severe urinary tract injury) were compared and analyzed between the 2 groups. There were no statistically significant differences in the average age, sex, stone diameter, stone type, and underlying diseases between the 2 groups (P > .05). The FURS-HLL group had significantly less intraoperative blood loss, shorter hospital stays, and longer operation time than the PCNL group (P < .05). The postoperative infection rate and the 1-week stone-free rate were lower in the FURS-HLL group than in the PCNL group (P < .05). However, there were no statistically significant between-group differences in postoperative fever, hematuria, urinary tract injury, 1-month stone-free rate, and the rate of secondary surgery (P > .05). FURS-HLL can significantly improve the stone-free rate and reduce postoperative complications, making it an ideal surgical approach for elderly patients with complex upper urinary tract calculi.