Flexible ureteroscopy vs. percutaneous nephrolithotomy for upper ureteral calculi: efficacy and postoperative quality...

This study compared the clinical efficacy and postoperative quality of life of flexible ureteroscopy (fURS) versus percutaneous nephrolithotomy (PCNL) in patients with upper ureteral calculi (UUC). A total of 152 patients with UUC treated at Renhuai People's Hospital between January 2024 and January 2026 were enrolled and divided into two groups based on the surgical procedure received: a fURS group (n=75) and a PCNL group (n=77). Outcomes included clinical efficacy, stone-free rates at 1 week and 1 month post-surgery, surgical metrics (bleeding volume (BV), operative time (OT), hospital length of stay (HLOS)), postoperative pain (POP; Visual Analogue Scale (VAS)), inflammatory markers (interleukin (IL)-6, IL-8, high-sensitivity C-reactive protein (hs-CRP)), hemorheology (plasma viscosity (PV), low/high shear (LS/HS), hematokrit (HCT)), clinical safety outcomes, and quality of life (Generic Quality Of Life Inventory-74 (GQOLI-74)). The PCNL group had a significantly higher overall clinical efficacy rate than the fURS group, with comparable 1-week and 1-month stone-free rates between groups. Patients receiving fURS had less bleeding and shorter hospital stays than PCNL patients, while OTs were similar. The fURS group had lower VAS scores on postoperative days 1 and 3, as well as lower inflammatory and hemorheological marker levels on day 3, compared to the PCNL group. The clinical safety of the two procedures was equivalent. The postoperative GQOL-74 scores across domains were higher in the fURS group than in the PCNL cohort. PCNL offers a higher efficacy rate in UUC patients, with stone-free rates comparable to fURS at 1 week and 1 month post-surgery. However, fURS is clinically advantageous in terms of bleeding (less), recovery (faster), and short-term POP (milder). fURS also better suppressed postoperative inflammatory rises, had a milder effect on hemorheological parameters, and was associated with better postoperative quality of life.