Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal pelvic stone more than 2 centimeters: a prospective randomized controlled trial

Abstract

This study aimed at investigating the efficacy and safety of retrograde intrarenal surgery (RIRS) in treatment of renal pelvic stone larger than 2 cm against the percutaneous nephrolithotomy (PCNL). Between March 2018 and December 2020, 121 patients were randomized to undergo PCNL (60 patients), or RIRS (61 patients). Both groups were compared in terms of operative time, intraoperative complications. Postoperative complications were assessed based on Clavien-Dindo grading system. Stone-free rates were evaluated by CT scan 6 weeks after surgery. No significant difference were observed between both groups in perioperative criteria. The main operative time was slightly longer in PCNL group (105 vs 95 min, p = 0.49). Stone clearance was higher in PCNL, yet the difference was not significant. (53 patients in PCNL group had either complete clearance or residual fragments < 4 mm, compared to 49 in RIRS group (p = 0.22). Blood transfusion rate was 8.3% in PCNL compared to 1.6% in RIRS group, with a trend towards significance (p = 0.08). Post-operative fever was higher in RIRS, yet it fell just short of statistical significance (13.1% vs 5.0%, p = 0.12). Compared to PCNL, RIRS displayed acceptable efficacy with less risk of bleeding requiring transfusion. It can be applied to patients with large renal pelvic stone as an alternative to PCNL.

Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy

“…However, nowadays, there is yet not a unified definition and we aimed to be more rigorous in terms of PCNL outcomes. In fact, it should be mentioned that SFR in our series was lower compared to that reported by different authors for the treatment of kidney stones with mPCNL (range 80-95%) [37,38]. However, in the previous series, the authors considered SF also cases with residual fragments of < 4 mm or used plain X-ray for evaluation, thus partially explaining the difference in SFR with our series.…”

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy results for 20-30 mm kidney stones: A matched-pair analysis

“…The most recent meta-analysis found during literature search, which compared mini PNL (mPNL) to RIRS for renal stones 2-3 cm, showed an advantage of mPNL over RIRS in terms of SFR, need for an auxiliary procedure, while blood loss, fluoroscopy time and hospital stay were significantly different in favor of RIRS (11). A very recent prospective randomized controlled trial on the same topic demonstrated no significant difference in any of the comparing parameters, while stone clearance was only slightly higher in the PNL group (12).…”

New infundibulopelvic angle measurement method can predict stone-free rates following retrograde intrarenal surgery

“…Although PCNL is more effective, it is associated with a higher complication rate and a longer hospital stay 21 . In cases where PCNL is contraindicated or not preferred by the patient, RIRS can be considered an alternative option 4 . Additionally, with significant technological advancements in the field of RIRS, studies have indicated that RIRS can also achieve successful treatment of kidney stones even those larger than 30 mm 21 , 22 .…”