Retrograde Intrarenal Surgery (RIRS) Versus Mini Percutaneous Nephro-Lithotripsy (Mini PCNL) To Treat Renal Stones 20 Mm Or Larger In Diameter Using Holmium :YAG Laser

Abstract

Objective: To evaluate the efficacy and safety of mini percutaneous nephro-lithotripsy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones 20mm or larger in its longest diameter using holmium: YAG laser. Patients & Methods: In a prospective randomized study including 40 patients divided into two groups each 20 patient. Group A included 15 males and 5 females with age ranged from 26 to 62 years had mini PCNL using holmium:YAG laser lithotripsy for renal pelvic and calyceal stones. Group B included 12 males and 8 females with age ranged from 21 to 74 years old had RIRS. Flexible ureteroscopy was used for pelvic and calyceal stones and semi-rigid ureteroscope was used for only renal pelvic stones using holmium:YAG laser (dusting approach). In both groups the procedure outcome in terms of Operative time, Blood loss, hospital stay, complications using modified Clavien grading system , the need of auxiliary procedures , stone free rates after 3 weeks by using CTUT, were evaluated statistically. Results: Statistical analysis of the data showed that there was insignificant difference between the {mean ± SD} of the BMI in patients of group A which was {27.850±3.183} kg/m2; while in patients of group B was {29.700±7.927} kg/m2 . Regarding stone size, there was insignificant difference between the {mean ± SD} of group A which was {2.665 ± 0.470} cm, while in group B was {2.430 ± 0.255} cm. Regarding the operative time the {mean ± SD} of group A was {100.25±12.9} minutes which was significantly (P<0.05) lower compared to group B {120.3±13.4} minutes. As regarding hospital stay it was significantly (P<0.05) higher in group A {3.4500 ±0.604} days compared to group B {1.2500 ± 0.638} days. Blood loss in terms of the {mean ± SD} change in Hb level in group A was {1.098±0.398} gm/dl which was significantly higher (P<0.05) when compared to group B {0.456±356} gm/dl. Regarding stone free rate 80 % of patients treated with group A were stone free (16 out of 20), while in group B 65% of patients were stone free (13 out of 20) after 3 weeks by using CTUT imaging. Regarding auxiliary procedures 4 patients underwent auxiliary procedures in group A while 6 patients underwent auxiliary procedures in group B. Regarding complications using modified Clavien grading system there were 6 patients in group A (3 patients had grade I, 2 patients had grade II , 1 patient had grade III), while 3 patients in group B (2 patients had grade I and one patient had grade II) Conclusion: In patients with renal stones 20 mm or larger, results showed that mini PNCL has higher stone free rate and shorter operative time than RIRS in expense of higher complications rate, blood loss, and longer hospital stay.