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Abstract
PurposeTo assess the safety, efficacy, and cost-effectiveness of flexible mini-percutaneous nephrolithotomy (F-mPCNL) in managing nephrolithiasis compared to retrograde intrarenal surgery (RIRS).Methods130 adult patients with renal stones (1.5–3 cm) were randomized to F-mPCNL or RIRS. The stone-free rate (SFR) was our primary outcome. Secondary outcomes were the operative time, fluoroscopy time, DJ stent insertion rate, auxiliary procedure needed, hospital stay, complications rate, total cost, and quality of life for both procedures.Resultsout of 130 patients in our study, 125 were evaluated and completed the follow-up period. Preoperative data was similar in both groups including stone characteristics. F-mPCNL showed a better SFR of 95.1% compared to 77.8% in the RIRS group (p-value˂0.001), this was associated with less need for additional procedures. F-mPCNL was associated with a shorter operation time of 47.60 ± 14.54 min compared to 59.30 ± 20.10 min in the RIRS group (p-value˂0.001). F-mPCNL showed less radiational exposure and less need for DJ stent insertion than RIRS. The overall complication rate was comparable in both groups, postoperative pain, need for extra doses of analgesics, and hospital stay were higher in the F-mPCNL group. In our study, F-mPCNL was shown to be more cost-effective than RIRS.ConclusionF-mPCNL showed a superior SFR in treating renal stones compared to RIRS in a single session, with less need for auxiliary procedures, shorter operative time, less radiational exposure, and better quality of life. However, it was associated with slightly more hospital stay and postoperative pain compared to RIRS.
Highlights
Retrograde Intrarenal Surgery (RIRS) is an effective minimally invasive treatment for renal stones
Invasive percutaneous nephrolithotomy has emerged as an effective, and less invasive treatment option for removing large renal stones compared to conventional PCNL
The mean operative time in the flexible mini-percutaneous nephrolithotomy (F-Minimally invasive percutaneous nephrolithotomy (mPCNL)) was 47.60 ± 14.54 min compared to 59.30 ± 20.10 min in the RIRS with a highly significant difference (p-value0.001)
Summary
Retrograde Intrarenal Surgery (RIRS) is an effective minimally invasive treatment for renal stones. RIRS has some disadvantages, such as the lower efficacy of stone clearance compared to PCNL, which is directly proportional to the stone size. This raises the need for a DJ stent to allow the passage of fragments smoothly leading to repeated interventions, exposing the patient to lower urinary tract symptoms (LUTS), and affecting their quality of life (QoL) [5]. Invasive percutaneous nephrolithotomy (mPCNL) has emerged as an effective, and less invasive treatment option for removing large renal stones compared to conventional PCNL. The rigidity of such nephroscopes limits maneuvering into renal calyces at acute angles This limitation may require additional percutaneous tracts, leading to increased morbidity [5–7]
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