Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

Kursad Zengin,Nevzat Can Sener,Serhat Tanik,M Abdurrahim Imamoglu,Can Tuygun,Sebahattin Albayrak,Nihat Karakoyunlu,Hasan Bakirtas,Mesut Gurdal

doi:10.1155/2015/914231

Kursad Zengin, Nevzat Can Sener + Show 7 more

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https://doi.org/10.1155/2015/914231

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Abstract

Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

Highlights

Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology
The approach attracted a great deal of attention and it was suggested that larger stones could be treated, albeit over longer operative times
Some urologists have suggested that RIRS, which is associated with fewer complications and less morbidity, should be used to treat large stones

Summary

Introduction

Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. RIRS renders smaller kidney stones more accessible and upper urinary tract tumors treatable, using minimally invasive methods [1]. RIRS was first used to treat small kidney stones [2]. The approach attracted a great deal of attention and it was suggested that larger stones could be treated, albeit over longer operative times. Medium and larger stones were treated via RIRS [3]. Some urologists have suggested that RIRS, which is associated with fewer complications and less morbidity, should be used to treat large stones . The EAU guidelines mention that RIRS is the first choice of some surgeons who treat larger stones [4, 5]

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