Retrograde Intra-Renal Surgery Versus Percutaneous Nephrolithotomy in Management of Renal Stone 10-20 Millimeters, A Comparative Clinical Study

Abstract

Purpose: comparison the efficacy and safety of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones. Patients and Methods: Records of patients who underwentsurgery for renal stone were retrospectively reviewed, for two years from the beginning of 2017 till the endof 2019. Patients who had renal stones between 10 - 20 Millimeter and located in different renal caliceswere included, patients who underwent percutaneous nephron-lithotomy PNL and retrograde intra-renalsurgery RIRS were defined as Group I and Group II, respectively. Patient criteria (age, sex, BMI); the stonecharacteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complications (bleeding,pain, infection, visceral injury, conversion to open surgery, and need for blood transfusion) were evaluatedbetween the treatment groups. Result: There were no significant differences in terms of age, gender, BMI,laterality, number of stones, Hounsfield units and surface area characteristics of the stone between the PNL(n 25) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P =.080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) inGroup I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P= .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001,P < .001 and P < .001, respectively). Conclusion: RIRS is more effective and more reliable procedure thanPNL with higher stone-free and lower complication rates in treatment of single renal stone (10 t0 20 mm).