A randomized study comparing mini PCNL and RIRS for renal stones between 8 mm and 15 mm – A single institutional experience

Abstract

Background: Renal stone disease presents a persistent challenge in urology, necessitating advancements in minimally invasive techniques for enhanced patient outcomes. Retrograde intrarenal surgery (RIRS) and mini percutaneous nephrolithotomy (mPCNL) have emerged as contemporary modalities to address intermediate‑sized renal stones (8–15 mm) with precision and reduced invasiveness. Aims: To provide a comparative analysis of RIRS and mini PCNL in managing intermediate sized renal stones. To evaluate stone clearance rates, operative metrics, complications, and patient reported outcomes was integral to identifying optimal treatment strategies. Methods: Participants randomized to RIRS or mPCNL groups, with stone clearance rate as the primary outcome. Secondary measures included operative time, complication profiles, pain management, and the need for additional procedures. Results: The demographic data were comparable in our study. The stone size was 11.282 ± 1.7996 mm in mPCNL group and 11.248 ± 2.0340 mm in RIRS group. The fluoroscopy time was 49.40 ± 2.515 s in the RIRS group and 77.28 ± 2.466 s in the mPCNL group. There was a statistically significant variance in the operative time. After a month, the stone‑free rates were 96% and 90% in the mPCNL and RIRS groups, respectively. Conclusion: Our study emphasizes the importance of tailored treatment approaches based on patient characteristics. The overall operative time is higher in RIRS group, while the fluoroscopy time, complications, hemoglobin fall, and mean duration of hospital stay are higher in PCNL group. However, the stone clearance rates in both procedures have been remarkable. It is prudent to leave it to the discretion of the operating surgeon to choose the appropriate procedure for a given patient considering the variables.