DOI: 10.4103/ua.ua_25_26 ISSN: 0974-7796

Super-mini percutaneous nephrolithotomy versus flexible ureteroscopy for renal stones ≤20 mm: A single-center randomized controlled trial with cost analysis and safety outcomes

Minh Tuan Nguyen, Minh Phuc Cao, Truong Giang Nguyen, Tien Chau Vu, Quoc Khanh Tran
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Abstract

Context:

Super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (fURS) are minimally invasive for small renal stones, but comparative data on safety and cost in resource-limited settings are scarce.

Aims:

The aim of this study was to compare the efficacy, safety, and cost of SMP and fURS for renal stones ≤20 mm.

Settings and Design:

This was a single-center, open-label randomized controlled trial at a tertiary-care hospital in Vietnam (2024).

Materials and Methods:

Patients were randomized to SMP or fURS. The primary outcome was the stone-free rate (SFR) at 1 month, assessed by an independent blinded radiologist. The secondary outcomes included operative time, hemoglobin drop, hospital stay, complications, and total cost. Analysis was performed on an intention-to-treat basis. This trial is reported in accordance with the CONSORT 2025 statement (Supplementary File 1).

Statistical Analysis Used:

Continuous variables were compared using Student’s t -test or Mann–Whitney U test. Categorical variables were analyzed using Chi-square or Fisher’s exact tests where appropriate. P <0.05 was considered statistically significant.

Results:

The operative time was significantly shorter with SMP than fURS (65.42 ± 12.14 vs. 78.86 ± 13.66 min; P < 0.001). SMP showed a greater hemoglobin decrease (0.97 ± 0.77 vs. 0.43 ± 0.28 g/dL; P < 0.001) and a longer hospital stay (2.86 ± 0.76 vs. 2.17 ± 0.38 days; P < 0.001). At 1 month postoperatively, the primary SFR was higher in the SMP group than in the fURS group (94.4% vs. 88.9%); however, the difference was not statistically significant (risk difference, 5.6%; 95% confidence interval, −7.4% to 18.5%; P = 0.397). Total treatment cost was significantly lower in the SMP group ( P < 0.001).

Conclusions:

Both procedures are safe and effective. SMP reduces operative time and cost, while fURS results in less blood loss and shorter hospital stay.

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