Management of Anteriorly Located Renal Caliceal Stones with Two Different Techniques (Mini-Percutaneous Nephrolithotomy <i>vs</i> Flexible Ureteroscopic Laser Lithotripsy): A Critical Comparative Evaluation of the Outcomes

<b><i>Purpose:</i></b> To evaluate the efficacy and safety of two different approaches, flexible ureteroscopic laser lithotripsy (fURS) and mini-percutaneous nephrolithotomy (mini-PCNL), for the minimally invasive management of anteriorly located caliceal stones in a location-based manner. <b><i>Materials and Methods:</i></b> A total of 93 patients with anterior caliceal stones (<15 mm) were treated with following two different modalities: fURS (<i>n</i> = 52, 55.9%) (Group 1) and mini-PCNL (<i>n</i> = 41, 44.1%) (Group 2). Demographic, per-operative, and postoperative parameters were comparatively evaluated in both groups. <b><i>Results:</i></b> The groups were similar in terms of their demographic data and stone characteristics (<i>p</i> > 0.05). Operation, fluoroscopy time, and hospital stay were significantly longer in Group 2 (<i>p</i> < 0.001). The perioperative complication and overall stone-free rates were similar between the groups (<i>p</i> = 0.44 and <i>p</i> = 0.53, respectively). However, when the stone-free rates were examined according to the calix groups, Group 2 was significantly more effective in terms of stone-free rates in the lower calix (52% <i>vs</i> 84%, <i>p</i> = 0.03). Although not statistically significant, more postoperative complications were observed in Group 2 (<i>p</i> = 0.09). <b><i>Conclusion:</i></b> Our findings demonstrate that although mini-PCNL may be performed well through a caliceal puncture to remove lower caliceal stones with a high stone clearance rate, the fURS approach may be safer and more rational for the removal of stones located in the middle and upper anterior calices.