Inclusion criteria: stones with a low likelihood of spontaneous passage, persistent pain despite adequate analgesic medication; persistent obstruction, stone growth, or infection; stones located in the renal pelvis (including pelvic-ureteral junction), upper or middle calyx, stone size between 6 and 20 mm, age ≥ 18 years, body mass index (BMI) < 30 kg/m2, ureter stone density ≤ 1000 Hounsfield’s units (HU), and skin to a stone distance less than 11 cm. Recurrent or first-time stone formers were both eligible; Patients with a previous history of urinary stones were only included if they were stone-free for at least 12 months.
Exclusion criteria: pregnancy, coagulopathy, uncontrolled urinary tract infection, severe skeletal malformations, which prevent targeting of the stone; arterial aneurysm in the vicinity of the stone, multiple kidney stones, anatomical obstruction distal to the stone, or congenital urinary anomaly (such as horseshoe kidney or ileal conduit), patients with JJ-stent/nephrostomy insertion before treatment for the resolution of urinary tract obstruction, transplanted kidney, solitary kidney, renal insufficiency (elevated creatinine); stones located in the diverticular neck or a diverticulum.
Decision-making process: patients were given a choice to undergo either F-URS or SWL after counseling them about the advantages and drawbacks of both procedures (such as stone-free rates, costs, hospital duration, and complications). After receiving the explanation, the patients selected the method they preferred. After the patients provided informed consent, the chosen procedure was performed by experienced senior doctors.
Exclusion criteria: pregnancy, coagulopathy, uncontrolled urinary tract infection, severe skeletal malformations, which prevent targeting of the stone; arterial aneurysm in the vicinity of the stone, multiple kidney stones, anatomical obstruction distal to the stone, or congenital urinary anomaly (such as horseshoe kidney or ileal conduit), patients with JJ-stent/nephrostomy insertion before treatment for the resolution of urinary tract obstruction, transplanted kidney, solitary kidney, renal insufficiency (elevated creatinine); stones located in the diverticular neck or a diverticulum.
Decision-making process: patients were given a choice to undergo either F-URS or SWL after counseling them about the advantages and drawbacks of both procedures (such as stone-free rates, costs, hospital duration, and complications). After receiving the explanation, the patients selected the method they preferred. After the patients provided informed consent, the chosen procedure was performed by experienced senior doctors.
