Analysis of Treatment Preference Factors and Lithotripsy Outcomes in Patients with 20-25 mm Kidney stones in Songjiang District, Shanghai

Abstract Purpose: This study aims to analyze the preferences of patients with 20-25 mm kidney stones in Songjiang District, Shanghai, for two treatment options: flexible ureteroscopy lithotripsy (FURL) and percutaneous nephrolithotomy (PNL), as well as the factors influencing these preferences. Additionally, it seeks to compare and analyze the lithotripsy outcomes of these two surgical methods. Methods: A retrospective analysis was conducted on 173 patients who underwent surgical intervention for kidney stones (ranging from 20 mm to 25 mm in diameter) at Songjiang hospital affiliated to Shanghai jiaotong university school of medicine, between January 2022 and December 2024. Basic patient demographics and preoperative clinical data were recorded, along with surgical duration, length of hospital stay, and postoperative complications. Stone clearance rates were monitored during follow-up. A questionnaire survey, combined with conjoint analysis, was employed to evaluate patients' prioritization of four treatment attributes: length of hospital stay, stone-free rate (SFR), presence of surgical incisions, and risk of postoperative infection. Patients were categorized into two age groups: <60 years and ≥60 years, and differences in treatment preferences between these two groups were compared. Result：All patients successfully underwent surgery. There were no significant differences in baseline characteristics and stone burden between the FURL and PNL groups (P>0.05). Among the 173 patients, there was a significant difference in the preference for FURL (61.2%) versus PNL (38.8%) (P<0.05). The patients' ranking of the importance of treatment attributes was as follows: SFR (42.9%), presence of surgical wounds (24.8%), length of hospital stay (17.7%), and risk of postoperative infection (14.6%). The operative time in the FURL group was significantly longer than that in the PNL group, with a statistically significant difference (P<0.01); however, there were no significant differences between the two groups in terms of length of hospital stay, postoperative complication rate, and stone clearance rate (P>0.05). Patients in the <60 years old group were more inclined to choose FURL, with the primary considerations being SFR (40.12%) and presence of surgical wounds (30.58%). Patients ≥60 years old considered SFR (45.99%) and length of hospital stay (20.99%) to be more important and were more likely to opt for PNL. Conclusions: In the Songjiang district of Shanghai, patients with kidney stones measuring 20-25 mm in diameter exhibit a preference for FURL over PNL when selecting a surgical method, despite the lack of significant differences in complication rates and SFR between the two procedures. However, the operative time for FURL is significantly longer than that for PNL. Patients younger than 60 years old place greater emphasis on the presence or absence of surgical wounds and tend to opt for FURL, while patients aged 60 years and older consider the length of hospital stay to be more important and are more likely to choose PNL. Patient preferences are influenced by multiple treatment attributes, and clinical decision-making should be optimized to enhance patient satisfaction and treatment outcomes.