Análisis comparativo entre nefrolitotomía percutánea y ureteroscopia flexible en litiasis renal de 2-3cm

espanolIntroduccion Comparar la nefrolitotomia percutanea y la ureterorrenoscopia flexible para el tratamiento de la litiasis renal entre 2 y 3cm. Material y metodos Estudio prospectivo, comparativo, no aleatorizado en 108 pacientes con litiasis renal entre 2 y 3cm; a 54 se les realizo nefrolitotomia percutanea y a 54 una ureteroscopia flexible. Las variables comparadas son: tasa libre de litiasis (%), tiempo quirurgico, requerimiento de proceso auxiliar, complicaciones postoperatorias, estancia hospitalaria, tasas de reingreso y tiempo de recuperacion. Resultados No existieron diferencias en la tasa libre de litiasis entre ambas tecnicas quirurgicas (76% ureteroscopia, 87% nefrolitotomia) (p=0,1), ni en las complicaciones (nefrolitotomia: 29%; ureteroscopia: 27%; p=0,4). Se ha requerido mayor numero de procesos auxiliares en el grupo de ureteroscopia (20%) frente al de nefrolitotomia (7%) (p=0,04). El tiempo quirurgico fue mas largo en el grupo de nefrolitotomia (121±52min) que en el grupo de ureteroscopia (93±42min) (p=0,004). El grupo de ureteroscopia tuvo menor estancia hospitalaria (2,1±1,6 vs. 3,9±1,9 dias, p=0,002), menor convalecencia (8,1±4,9 vs. 13,3±4,2 dias, p=0,005) y mayores tasas de reingreso (7,4% vs. 0%, p=0,05) que el grupo de nefrolitotomia. Conclusiones La nefrolitotomia y la ureteroscopia tienen una eficacia similar para el tratamiento de la litiasis renal entre 2-3cm, sin diferencias en las complicaciones. La ureteroscopia tiene menor estancia hospitalaria, una recuperacion mas rapida pero mayor reingreso y necesidad de procedimiento auxiliar. EnglishIntroduction To compare percutaneous nephrolithotomy and flexible ureterorenoscopy for treating kidney stones between 2 and 3cm. Material and methods A prospective, comparative, nonrandomised study was conducted with 108 patients with kidney stones between 2 and 3cm. Fifty-four patients underwent percutaneous nephrolithotomy and 54 underwent flexible ureteroscopy. We compared the following variables: lithiasis-free rate (%), surgical time, the need for an auxiliary process, postoperative complications, hospital stay, readmission rates and recovery time. Results There were no differences in the lithiasis-free rate between the 2 surgical techniques (76% for ureteroscopy vs. 87% for nephrolithotomy; P=.1) or in the complications (29% for nephrolithotomy vs. 27% for ureteroscopy; P=.4). A larger number of auxiliary process were needed for the ureteroscopy group (20%) than for the nephrolithotomy group (7%) (P=.04). The surgical time was longer for the nephrolithotomy group (121±52min) than for the ureteroscopy group (93±42min) (P=.004). The ureteroscopy group had shorter hospital stays (2.1±1.6 vs. 3.9±1.9 days; P=.002), shorter convalescence (8.1±4.9 vs. 13.3±4.2 days; P=.005) and higher readmission rates (7.4% vs. 0%, P=.05) than the nephrolithotomy group. Conclusions Nephrolithotomy and ureteroscopy have similar efficacy for treating kidney stones measuring 2-3cm, with no differences in complications. Ureteroscopy results in shorter hospital stays, quicker recoveries but more readmissions and a greater need for auxiliary procedures.