Flexible Ureteroscopy Versus Minipercutaneous Nephrolithotomy for 2 to 4 cm Renal Stones: A Systematic Review and Meta-Analysis
In brief
Flexible ureteroscopy halves complication rates versus mini-PCNL for 2-4 cm stones
In a meta-analysis of 20 studies (2326 patients), flexible ureteroscopy achieved stone-free rates comparable to mini-PCNL but cut overall complications by about half and shortened hospital stays by roughly one hour, with less blood loss and fewer transfusions. The findings suggest FURS is a safer primary option for large renal stones, though long-term outcomes and cost implications remain to be defined.
- Journal
- Journal of endourology (Q1)
- Published
- 12 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mohab Alsaid Saad, Aya M Nasr, Tasbih Fawzi Keshk, Rama Farid Qudaih, Alsayed Saad Abdelaziz, Mostafa Said
- PMID
- 42583730
- DOI
- 10.1177/08927790261475450
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 16 August 2026): Ranked by evidence level and journal quartile
- Picked for Nephrology (top studies of the week, 16 August 2026): Flexible ureteroscopy vs mini‑PCNL for 2‑4 cm stones meta‑analysis
- Picked for Urology (top studies of the week, 16 August 2026): Meta‑analysis of FURS vs mini‑PCNL for 2‑4 cm renal stones
Abstract
BACKGROUND: As the global prevalence of urolithiasis rises, selecting the optimal surgical intervention for large renal stones remains critical. Although percutaneous nephrolithotomy (PCNL) is the standard for stones more than 2 cm, the choice between flexible ureteroscopy (FURS) and mini-PCNL (mPCNL) for these burdens is debated. This systematic review and meta-analysis compares the efficacy and safety of FURS versus mPCNL for kidney stones measuring 2 to 4 cm. METHODS: Following the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of electronic databases identified randomized controlled trials and observational studies comparing FURS and mPCNL in adults with large renal stones of 2 to 4 cm. Primary outcomes included operative time, length of hospital stay, blood loss, hemoglobin drop, stone-free rate (SFR), and overall complication rates. RESULTS: A total of 20 studies involving 2326 patients were included. The pooled analysis revealed no statistical significance in the overall SFR across groups between FURS and mPCNL (mean difference [MD] = 0.98, 95% confidence interval [CI] [0.95; 1.01], p < 0.1330). Conversely, FURS demonstrated a superior safety profile, with significantly shorter hospital stays (MD = -57.10, 95% CI [-84.10; -30.11], p < 0.0001), reduced hemoglobin drop (MD = -0.75, 95% CI [-1.42; -0.07], p = 0.03), and lower blood transfusion rates (risk difference [RD] -0.02, 95% CI [-0.03; -0.01], p = 0.0013). FURS was associated with a statistically significant decrease in the overall complication incidence rates (risk ratio = 0.52, 95% CI [0.41; 0.65], p < 0.0001). CONCLUSION: FURS is a highly effective and safer alternative to mPCNL for managing 2 to 4 cm kidney stones. Although FURS and mPCNL offer close efficacy, FURS significantly minimizes surgical morbidity and hospitalization. The integration of advanced suctioning and laser technologies further positions FURS as a competitive primary treatment for large stone burdens.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.