LONG-TERM OUTCOMES OF MINIMALLY INVASIVE VERSUS OPEN SURGICAL APPROACHES IN MANAGEMENT OF UROLOGICAL STONE DISEASE

Abstract

Background: Urological stone disease remains a prevalent and recurrent condition worldwide, with surgical intervention often required in complex cases. While minimally invasive surgery (MIS) has become the preferred approach due to reduced morbidity, the long-term outcomes compared to traditional open surgery remain debated, particularly in terms of recurrence and complication rates.

Objective: To compare long-term patient outcomes, stone recurrence rates, and postoperative complications between minimally invasive and open surgical approaches for urological stone disease.

Methods: A retrospective cohort study was conducted from 2020 to 2025 across two tertiary care hospitals in Lahore, Pakistan. A total of 400 patients were included—200 treated with minimally invasive techniques (PCNL, URS, or ESWL) and 200 with open stone surgery. Data on demographics, comorbidities, operative characteristics, stone-free rates, complications (Clavien-Dindo classification), and recurrence at two years were analyzed. Statistical tests included independent t-tests, chi-square, and Kaplan-Meier survival analysis.

Results: Minimally invasive approaches showed significantly reduced operative time (78.4 vs. 112.7 minutes), hospital stay (2.1 vs. 4.6 days), and blood loss (120 vs. 320 ml) compared to open surgery (p < 0.001). Stone-free rates at discharge were comparable (92.5% vs. 94.0%), but recurrence at two years was significantly higher in the MIS group (19.5% vs. 12.0%, p = 0.01). Complication rates were not statistically different between groups.

Conclusion: Minimally invasive surgery provides clear short-term benefits, but open surgery yields superior long-term outcomes in terms of recurrence. Surgical strategy should be individualized based on stone complexity, patient factors, and long-term treatment goals.