Comparison Between Retrograde Intrarenal Surgery (Rirs) and Percutaneous Nephrolithotomy (Pcnl) in the Treatment of Single Renal Stone 2 - 3cm

Abstract

CONTEXT: Open surgery has given way to endoscopic surgeries. PCNL makes its way puncturing renal parenchyma where there is an unknown factor of damaging a major blood vessel. This may be overcome by retrograde intrarenal surgeries (RIRS) but the instrument has to traverse a long way through natural orifice and lumen. Which is less harmful and more helpful. AIM: To compare results from RIRS and PCNL in treating renal calculi of 2 to 3cm. MATERIALS AND METHODS:Retrospective analysis of consecutive patients who underwent PCNL or RIRS for stones with 20-30mm diameter, in a single institution between January 2008 and December 2014. RESULTS: Mean operative time for PCNL is significantly less as compared to RIRS (p=0.001). Hemoglobin drop was significantly high in PCNL group 1.2gm%. Stone clearance rate was much higher in PCNL group with 95.7% of the patients requiring only single procedure. CONCLUSION: PCNL is more effective than RIRS for stones between 2-3cm at a cost of longer hospital stay, increased blood loss, increased need for transfustions. KEYWORDS: Percutaneous nephrolithotomy, retrograde intrarenal surgery, minimal invasive, flexible ureterorenoscopy. INTRODUCTION:The development of minimal invasive surgery for the treatment of renal calculus has led to an increase in success rates and, at the same time, has decreased the morbidity associated with these treatments. Today, percutaneous nephrolithotomy (PCNL) is the gold standard in the management of renal stones larger than 2 cm, to the detriment of open surgery, which has been pushed into the background and is only indicated in exceptional cases. 1 PCNL, in turn, has evolved, to minimally invasive percutaneous procedures (MIPPs) including mini-PCNL and micro-PCNL. Although PCNL has long been the surgical treatment of choice for these complex stones, recent advances in flexible ureteroscopes, laser technology and surgical technique have led to an increased interest in performing RIRS which enables a complete management of the upper urinary tract.The possibility of combined anterograde (Percutaneous) and retrograde (Transurethral) management, thanks to the flexible ureteroscope and cytoscope, has given the standard PCNL greater access to calyces which were not reached with rigid nephroscopy, while allowing to complete renal calculus treatment with only a single percutaneous access site in most cases. The main drawbacks of retrograde access include the requirement of costly flexible scopes, decreased visualisation, reduced size of fragment removal, and the need for flexible lithotrites and baskets. 2 Cost is a major deterrent to RIRS, particularly in developing countries. 3 However, percutaneous approaches have traditionally provided enhanced capacity for stone removal, given the use of large-sheath diameters. This paradigm has recently changed with the progressive scaled down of devices for percutaneous access. PCNL techniques offer significant economic advantages due to the decreased reliance on disposable instrumentation.

Can mini PCNL achieve the same results as RIRS? The initial single center experience

“…The rate of the Hb drop after surgery was significant between the two groups (P value 0.0001). Other studies showed that the rate of the Hb drop is approximately around 1.2 gm, in our study the rate of the Hb drop was around 0.6 gm/dl in both group collectively but was relatively higher in miniPCNL group which is lower than other studies [ 5 , 17 , 18 ].…”