{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:45:11Z","timestamp":1792597511037,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>As the global prevalence of urolithiasis rises, selecting the optimal surgical intervention for large renal stones remains critical. Although percutaneous nephrolithotomy (PCNL) is the standard for stones more than 2 cm, the choice between flexible ureteroscopy (FURS) and mini-PCNL (mPCNL) for these burdens is debated. This systematic review and meta-analysis compares the efficacy and safety of FURS versus mPCNL for kidney stones measuring 2 to 4 cm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines, a comprehensive search of electronic databases identified randomized controlled trials and observational studies comparing FURS and mPCNL in adults with large renal stones of 2 to 4 cm. Primary outcomes included operative time, length of hospital stay, blood loss, hemoglobin drop, stone-free rate (SFR), and overall complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 20 studies involving 2326 patients were included. The pooled analysis revealed no statistical significance in the overall SFR across groups between FURS and mPCNL (mean difference [MD] = 0.98, 95% confidence interval [CI] [0.95; 1.01],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.1330). Conversely, FURS demonstrated a superior safety profile, with significantly shorter hospital stays (MD = \u221257.10, 95% CI [\u221284.10; \u221230.11],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001), reduced hemoglobin drop (MD = \u22120.75, 95% CI [\u22121.42; \u22120.07],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.03), and lower blood transfusion rates (risk difference [RD] \u22120.02, 95% CI [\u22120.03; \u22120.01],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.0013). FURS was associated with a statistically significant decrease in the overall complication incidence rates (risk ratio = 0.52, 95% CI [0.41; 0.65],\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>FURS is a highly effective and safer alternative to mPCNL for managing 2 to 4 cm kidney stones. Although FURS and mPCNL offer close efficacy, FURS significantly minimizes surgical morbidity and hospitalization. The integration of advanced suctioning and laser technologies further positions FURS as a competitive primary treatment for large stone burdens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08927790261475450","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:40:46Z","timestamp":1786527646000},"page":"1200-1212","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Flexible Ureteroscopy Versus Minipercutaneous Nephrolithotomy for 2 to 4 cm Renal Stones: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0802-4240","authenticated-orcid":false,"given":"Mohab Alsaid","family":"Saad","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya M.","family":"Nasr","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Alexandria Main university Hospital, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasbih Fawzi","family":"Keshk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama Farid","family":"Qudaih","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Al-Azhar University, Cairo, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alsayed Saad","family":"Abdelaziz","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Said","sequence":"additional","affiliation":[{"name":"Department of urology, Alexandria Main Hospital, Alexandria, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11030424"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2223-4683.2014.07.02"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-017-2008-6"},{"key":"e_1_3_2_5_1","volume-title":"StatPearls","author":"Thakore P","year":"2025","unstructured":"4.Thakore P, , Liang TH. 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