Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2cm from Guy's stone scoring system perspective.

Abstract

To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2cm, together with Guy's stone scores (GSS). The data of 811 patients with stone sizes 2-6cm were operated using PNL (n=361) and RIRS (n=450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P<.001), it was similar between the two groups in GSS grade 4 (P=.186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P<.001), and it raised up to 95.3% and 81.6% after secondary interventions (P<.001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P=.06). LOHS was longer in the PNL group (P<.001). Although LOHS was significantly longer only in GSS grade 3 (P=.043) and GSS grade 4 (P<.001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P<.001), but the difference did not differ between GSS grade 3 and 4. SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.