Clinical efficacy of flexible ureteroscopy with holmium laser lithotripsy for geriatric patients with complex upper urinary tract calculi

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.