Percutaneous Nephrolithotomy (PCNL) versus Retrograde Intrarenal Surgery (RIRS) in Medium Sized Renal Pelvic Stones

Abstract

Abstract Corresponding Background Stone size is a key factor in the determination of the success of author: treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery Aim of the Work to compare the outcome of PCNL and RIRS in medium sized renal pelvic stoned in adults regarding operative time, fluoroscopic time, intra and postoperative complications, stone free rate, hospital stay and postoperative stenting. Patients and Methods This prospective randomized clinical study was conducted on 30 patients from April 2019 to January 2020, all patients had single renal pelvic stone (10 to 20 mm) and had no contraindication to perform these operations at the Urology department, Ain Shams University Hospitals and National Institute of Urology and Nephrology. The patients were randomized by (1 : 1) manner for either PCNL or RIRS. All preoperative, intraoperative and postoperative parameters, results and complications between both groups were recorded. Results Mean fluoroscopic time and hospital stay were significantly greater in PCNL group than RIRS group. The stone free rate was 86.7% (13/15) in PCNL group and 80% (12/15) in RIRS group and for complications (according to Cliven-Dindo score) there were no statistically significant difference between two groups.Complications occurred in 3(20%) patients in PCNL group and in 2(13.3%) patients in RIRS group. PCNL and RIRS are safe and effective methods for medium sized renal pelvic stones. For selected patients, RIRS may represent an alternative therapy to PCNL, with acceptable efficacy and low morbidity. RIRS compared to PCNL offers the best outcome in terms of radiation exposure and hospital stay. Conclusion RIRS may represent an alternative therapy to PCNL, RIRS compared to PCNL offers the best outcome regarding radiation exposure and hospital stay.