ORIGINAL RESEARCH article
Front. Surg.
Sec. Genitourinary Surgery and Interventions
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1588563
Comparison of clinical efficacy, immune response and postoperative adverse reactions of transurethral holmium laser lithotripsy and percutaneous nephrolithotomy in elderly patients with complex upper urinary tract renal calculi: a retrospective cohort study
Provisionally accepted
- 1Affiliated Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
- 2Strategic Support Force Characteristic Medical Center, Beijing, China
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Objectives: This study aimed to evaluate the clinical efficacy, immune response, and postoperative adverse effects of transurethral holmium laser lithotripsy (RIRS) versus percutaneous nephrolithotomy (PCNL) in elderly patients with complex upper urinary tract renal calculi. Methods: A retrospective analysis was conducted on 70 elderly patients treated from January 2020 to January 2021. The control group (n=32) underwent PCNL, while the observation group (n=38) received transurethral holmium laser lithotripsy. Pre-and post-operative comparisons included serum creatinine (Scr), cystatin-C, kidney injury molecule-1 (KIM-1), immune indices, thyroxine (TH), and urokinase (UK). Stone clearance rates and adverse reactions were also assessed. Results: The observation group showed less bleeding, shorter hospital stays, higher hemoglobin decrease, and longer operation time (P<0.05). Higher stone clearance rates were observed in the RIRS group at 86.84% and 76.32% for first and second stages, compared to 65.64% and 53.13% in the PCNL group. Postoperatively, Scr, Cys-C, and KIM-1 levels were lower in the RIRS group. Both groups exhibited decreased CD4+ and CD4+/CD8+, increased CD8+, reduced TH, and elevated UK levels post-surgery (P<0.05). Adverse reactions were similar between groups. Conclusions: For elderly patients with complex renal calculi, transurethral holmium laser lithotripsy offers superior stone clearance and reduced renal damage compared to PCNL, despite a longer operation time. Consideration of individual patient conditions is crucial for selecting the optimal procedure.
Keywords: Transurethral holmium laser lithotripsy, retrograde intrarenal surgery (RIRS), PCNL, Elderly patients with complex upper urinary tract renal calculi, Immune reaction, postoperative adverse reactions
Received: 10 Mar 2025; Accepted: 01 Oct 2025.
Copyright: © 2025 Fu, Chen, Yi, Wu, He, Ping, Sang, Ge and Cheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wen Cheng, zhian171931@163.com
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