Comparison of Percutaneous Nephrolithotomy and Flexible Ureterorenoscopy in the Treatment of Single Upper Ureteral Calculi Measuring 1 to 2 cm

Background: To compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) in the treatment of single upper ureteral calculi measuring 1–2 cm. Methods: This randomized controlled trial was conducted at the Department of Urology, Institute of Kidney Diseases, Peshawar, over a period of three months from February 2025 to May 2025. A total of 104 patients meeting the inclusion criteria were enrolled and randomly assigned into two equal groups: Group A underwent PCNL, while Group B underwent FURS. Preoperative evaluation included non-contrast CT scan, serum creatinine, urine culture, and other routine investigations. Stone clearance at 3 months (confirmed by CT scan) was defined as the primary outcome, while secondary outcomes included operative time, intraoperative and postoperative complications. Data were analyzed using SPSS version 26, with p<0.05 considered statistically significant. Results: The mean operative time was significantly shorter in the PCNL group compared to FURS (74.2 ± 12.4 vs. 89.6 ± 14.1 minutes, p<0.001). The stone-free rate was markedly higher in the PCNL group (90.4%) compared to the FURS group (67.3%, p=0.004). Overall complication rates were similar between groups (28.8% vs. 23.1%, p=0.52), with fever, hematuria, and urinary tract infection being the most frequent events. Stratified analysis showed consistently superior clearance with PCNL across subgroups defined by age, gender, BMI, and urine culture status. Conclusion: PCNL provides superior stone clearance and shorter operative times compared to FURS in patients with single upper ureteral stones measuring 1–2 cm, while both procedures are safe and associated with acceptable complication rates. PCNL should be considered the preferred approach in this clinical scenario, whereas FURS remains a reasonable alternative for selected patients.