Efficacy Between Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For Renal Stones

Abstract

Background:

Renal stones, particularly those between 2 cm and 3.5 cm in size, present a significant challenge in urology. Despite the availability of modern techniques, the optimal treatment for stones within this size range remains a contentious issue. Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are two popular minimally invasive procedures used to treat renal stones. However, there is limited consensus on the superiority of one over the other in terms of clinical outcomes, complications, and patient satisfaction.

Objective:

To compare the clinical outcomes of PCNL and RIRS in the treatment of renal stones sized between 2 cm and 3.5 cm, specifically focusing on stone-free rate (SFR), complications, hospital stay, blood loss, the need for repeat procedures, and patient satisfaction.

Method:

This was a prospective, randomized study conducted from June 2024 TO December 2024 at CMH nephrology and urology department district peshawer, with 150 patients presenting with renal stones between 2 cm and 3.5 cm. The patients were randomly assigned to either the PCNL group (n = 75) or the RIRS group (n = 75). Preoperative imaging (CT or ultrasound) confirmed stone size. Patients with bilateral kidney stones, a history of previous kidney surgeries, or significant comorbidities were excluded. Clinical outcomes, including SFR, hospital stay, complications (postoperative fever, infection, stent-related symptoms), blood loss, and the need for repeat procedures, were analyzed. Patient satisfaction was also evaluated using a 1-10 scale.

Result:

The study found that PCNL had a significantly higher stone-free rate (95%) compared to RIRS (82%). The mean hospital stay for RIRS was shorter (1.56 ± 0.4 days) compared to PCNL (6.5 ± 1.2 days). While the incidence of postoperative postoperative infection was higher in the RIRS group (44% vs. 2.7%), blood loss was greater in the PCNL group (12% vs. 4%). The need for additional procedures was higher in the RIRS group, with 44% requiring further sessions, compared to just 2.7% in the PCNL group. Patient satisfaction was higher in the PCNL group (94.7%) compared to RIRS (77.3%).

The treatment of renal stones larger than 2 cm and smaller than 3.5  cm remains controversial, and Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) are two popular treatment options. This study compares these two techniques in terms of clinical outcomes, including stone-free rate (SFR), complications, hospital stay, and patient  satisfaction. This  prospective study was conducted June 2024 TO December 2024 at CMH neprology and urology department district peshawer involving 150 patients with renal stones who were randomized into two treatment arms, PCNL and RIRS, with 75 patients in each arm. They critically evaluated the following parameters: SFR, duration of hospital stay, blood loss during surgery, complications, requirement  for re-procedures, and patient satisfaction. The puncture access of the PCNL group was decided  according to the Guy's Score classification. The stone-free rate was significantly higher in the PCNL group (95%)  compared to the group treated with other methods (82%). The mean hospitalization time was shorter for RIRS (6.5  ± 1.2 vs. 1.56 ± 0.4 days). PostoperativePostoperative infective complications were seen more in the RIRS group (44%) along with the stent -related symptoms (34.6%) but had the least postoperative morbidity in the PCNL group (2.7% infection). Blood loss was greater  for the PCNL group (12%) compared to the RIRS group (4%), but both groups had low requirements for blood transfusions (2.7% for PCNL and 1.3% for RIRS). Furthermore, RIRS required a greater proportion of repeat sessions (44%) for total stone clearance, especially in cases involving larger stones or increased stone density, whereas PCNL  required fewer repeat procedures (2.7%). The patient satisfaction was excellent in the PCNL  group (94.7%) and was slightly higher than in the RIRS group (77.3%).

Conclusion:

Both PCNL and RIRS are effective treatments for renal stones between 2 and 3.5 cm, with PCNL offering superior stone-free rates and greater patient satisfaction, particularly for stones with favorable anatomy. RIRS is a less invasive approach but may require multiple sessions for complete stone clearance and is associated with a higher incidence of postoperative postoperative complications. The choice of procedure should be individualized based on patient characteristics, stone features, and treatment preferences.