Retrograde intra renal surgery (RIRS) versus percutaneous nephrolithotomy (PNL) as a primary treatment for large renal stones: A prospective randomized controlled trial

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Background Despite the high efficacy of percutaneous nephrolithotomy (PNL), it has more morbidity and a difficult learning curve. Retrograde intra renal surgery (RIRS) was introduced as a minimally invasive procedure for treatment of renal stones.Objective To compare RIRS versus PNL in the management of renal stones sized 2–3 cm.Patient and methods In this prospective randomized controlled trial, 122 patients with renal stones 2–3 cm were included and divided into two equal groups. Group A underwent RIRS. Group B underwent PNL. Patients with bleeding disorders, pregnancy, active UTI were excluded. Laboratory investigations, Ultrasound, CTUT were done preoperatively. Perioperative outcome (operative time, complications, hospital stay and pain score) was recorded. SFR (stone free rate) was assessed by CTUT after one month.Results The mean stone size for group A and B were 2.11 ± 0.21 and 2.12 ± 0.23, respectively. The Stone free rate was 70.5% in RIRS and 73.8% in PNL (p = 0.840). lithotripsy time was significantly longer in the RIRS group (84.75 vs 72.95 minutes) (p = 0.019). PNL group showed significant post-operative hemoglobin drop but with no need for blood transfusion. High-grade fever was slightly higher in the RIRS group (8.2% vs 6.5%) (p = 0.557). Sepsis developed in 4.9% of RIRS group and 1.6% of the PNL group (p = 0.362). One case of mortality was reported in the PNL group. The hospital stay was significantly longer in the PNL group. The mean pain score was significantly lower in the RIRS.Conclusion RIRS can be used as an alternative to PNL for the management of renal stones sized 2–3 cm, with comparable stone free rates, less hospital stays, less pain score, less hemoglobin drops. but longer lithotripsy time.

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