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

## TL;DR

This study compares two kidney stone treatments, RIRS and PNL, finding that RIRS offers similar success rates with fewer complications and shorter recovery times for stones 2–3 cm in size.

## Contribution

The study provides a direct comparison of RIRS and PNL for large renal stones through a prospective randomized trial.

## Key findings

- RIRS and PNL had comparable stone-free rates (70.5% vs 73.8%) for 2–3 cm stones.
- RIRS resulted in shorter hospital stays, less pain, and no blood transfusions compared to PNL.
- PNL had a longer lithotripsy time and a higher risk of sepsis and mortality.

## Abstract

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.

To compare RIRS versus PNL in the management of renal stones sized 2–3 cm.

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.

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.

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.