Rigid-only versus combined rigid and flexible percutaneous nephrolithotomy: a systematic review.

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PNL) is a standard treatment for kidney stones.
• The conventional rigid-only approach may have limitations for complex cases.
• Evidence supporting combined flexible techniques is limited.

Purpose of the Study:

• To systematically review literature comparing rigid-only PNL with combined flexible PNL.
• To evaluate the efficacy and safety of these techniques for large/complex upper urinary tract calculi.

Main Methods:

• Searched Ovid MedLine, PubMed, Scopus, and Web of Science databases.
• Included studies adhering to Preferred Reporting Items for Systematic Review and Meta-analysis criteria.
• Synthesized data from six studies involving 666 patients.

Main Results:

• Combined flexible PNL demonstrated higher stone-free rates (86.7-96.97%) with single access.
• Reduced need for secondary procedures was observed.
• Improved safety and shorter hospital stays (5.1-7 days) were noted.

Conclusions:

• The adjunct of flexible nephroscopy/ureteroscopy to rigid PNL benefits patients with large or complex urolithiasis.
• This combined approach optimizes surgical outcomes and patient recovery.