Comparative Outcomes of Mini-PCNL and Suction-Assisted Flexible Ureteroscopy in Patients with Renal Stones ≥ 2 cm

Abstract

Introduction: To compare the efficacy and perioperative outcomes of miniaturized percutaneous nephrolithotomy (mini-PCNL) and flexible ureteroscopy with flexible and navigable suction ureteral access sheath (FANS-UAS) in the management of renal stones larger than 2 cm. Material and method: This retrospective comparative study evaluated 252 adults with renal stones >= 2 cm treated between May 2024 and December 2025. Mini-PCNL was performed in 142 patients and FANS-UAS-assisted flexible ureteroscopy in 110. Preoperative non-contrast CT was used to characterize stones, and postoperative CT determined stone-free status as the primary endpoint. Operative time, hemoglobin drop, length of stay, Clavien-Dindo complications, and auxiliary intervention rates were analyzed as secondary outcomes. Results: Stone-free rates did not differ significantly between mini-PCNL and FANS-UAS-assisted flexible ureteroscopy (83.1% vs. 76.4%, p = 0.242). Mini-PCNL provided shorter operative times but resulted in greater hemoglobin decline, longer hospitalization, and more minor complications, while major complications were simi lar. Although mini-PCNL yielded higher stone-free rates in lower pole stones, this was not statistically significant. FANS-UAS was more frequently applied in older, comorbid patients and maintained satisfactory efficacy with a favorable perioperative profile. Conclusions: Both mini-PCNL and FANS-UAS-assisted flexible ureteroscopy achieved effective stone clearance for renal stones >2 cm. Mini-PCNL was faster, whereas FANS-UAS was associated with lower perioperative morbidity, despite lower adjusted odds of stone-free status compared with mini-PCNL. These results support an individualized approach to procedure selection in large renal stones, with stone burden, lower pole involvement, and patient comorbidity considered together in treatment planning.