Comparative Study between Ureteroscopy Using Thulium Fiber Laser (URS TFL) and Percutaneous Nephrolithotomy (PCNL) in the Treatment of Intra Renal Stones: A Prospective Study

Abstract

Background: Renal stone disease is a common urological condition worldwide, affecting approximately 5–15% of the population and leading to significant morbidity and healthcare utilization [1]. Percutaneous nephrolithotomy (PCNL) remains the standard treatment for renal stones larger than 2 cm due to its high stone‑free rate [2]. Recent technological advances have introduced the Thulium Fiber Laser (TFL), which provides efficient stone fragmentation with minimal retropulsion and improved visualization during ureteroscopy [3]. Objective: To compare the clinical outcomes, efficacy, and complications of ureteroscopy using Thulium Fiber Laser (URS‑TFL) versus Percutaneous Nephrolithotomy (PCNL) in the management of intra‑renal stones measuring 2–2.5 cm. Methods: This prospective comparative study included 90 patients with intra‑renal stones treated at the Surgical Specialties Center, Benghazi, Libya, from January 2020 to December 2025. Patients were divided into two equal groups: 45 patients underwent URS‑TFL and 45 patients underwent PCNL. Parameters evaluated included operative time, hospital stay, stone‑free rate, complications, and need for redo procedures. Results: URS‑TFL demonstrated shorter hospital stay (1–2 days) compared with PCNL (2–3 days) (p = 0.001). However, PCNL showed a significantly higher stone‑free rate, with fewer redo procedures (6.7% vs 33.3%) (p = 0.004). Complications were minimal in both groups. Conclusion: Both URS‑TFL and PCNL are safe and effective treatment options for intra‑renal stones measuring 2–2.5 cm. PCNL provides superior stone clearance, whereas URS‑TFL offers reduced invasiveness and shorter hospitalization.