Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

Abstract

PurposeTo investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx.Materials and MethodsPatients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups.ResultsPatients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4±13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status.ConclusionsRIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

Comparison of the stone-free rates of mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and retrograde intrarenal surgery for renal stones: A systematic review and network meta-analysis

“…8 studies compared PCNL versus mPCNL treatments [5,[23][24][25][26][27][28][29]. 10 studies compared PCNL versus RIRS treatments [30][31][32][33][34][35][36][37][38][39]. 7 studies compared mPCNL versus RIRS treatments [40][41][42][43][44][45][46] (Fig.…”

Current trends and pitfalls in endoscopic treatment of urolithiasis

“…In general, although the first recommended treatment option for a renal stone >20 mm is PCNL, RIRS for such stones appears to be a viable option given the current state of the art and minimal invasiveness. According to several recent studies carried out in high‐volume centers, the SFR of renal stones 20–35 mm in size is 71–96% . Although it is possible for highly skilled surgeons to successfully carry out single procedures for larger renal stones, in several cases staged procedures might be required.…”

“…According to several recent studies carried out in high-volume centers, the SFR of renal stones 20-35 mm in size is 71-96%. [15][16][17] Although it is possible for highly skilled surgeons to successfully carry out single procedures for larger renal stones, in several cases staged procedures might be required. 19 However, it is difficult to ascertain preoperatively whether or not there will be failed access to the ureter.…”

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

“…RIRS can be used to deal with LPSs of 1.0-2.0 cm, while Percutaneous nephrolithotripsy (PCNL) is mainly used to deal with LPSs with larger diameter or when RIRS failed to resolve the stone. With the growing advancement of medical devices and technologies, the application of RIRS has gradually expanded to kidney stones with a size of more than 2.0 cm or even more than 3.0 cm [3,4]. On the other hand, many emerging miniaturized PCNL technologies, including UMP, which can reduce the risk of kidney injury after surgery, are also increasingly used for the treatment of stones [5][6][7].…”