Skip to main content
SpringerLink
Log in

Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20–30 mm) stones? A critical evaluation

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2–3 cm.

Methods

A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group.

Results

The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1–2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3–4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success.

Conclusions

mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2–3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

All datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. European Association of Urology. Urolithiasis 2021 [Available from: http://uroweb.org/guideline/urolithiasis/.

  2. Ganpule AP, Bhattu AS, Desai M (2015) PCNL in the twenty-first century: role of Microperc, Miniperc, and Ultraminiperc. World J Urol 33(2):235–240

    Article  Google Scholar 

  3. Sakr A, Salem E, Kamel M et al (2017) Minimally invasive percutaneous nephrolithotomy vs. standard PCNL for management of renal stones in the flank-free modified supine position: single-center experience. Urolithiasis 45(6):585–589

    Article  Google Scholar 

  4. Li Y, He Q, Bao J et al (2020) Forecast and guiding role of using hounsfield unit in retrograde intrarenal surgery for the treatment of renal stone of 2–3 cm: a single center prospective study. Res Square. https://doi.org/10.21203/rs.3.rs-59924/v1

    Article  Google Scholar 

  5. Zeng G, Zhu W, Li J et al (2015) The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol 33(8):1159–1164

    Article  Google Scholar 

  6. El Shazly A, Taleb A, Ahmed A et al (2020) Mini-percutaneous nephrolithotomy (MPCNL) VS. Flexible ureterorenoscopy (RIRS) for renal stones> 2cm. Benha J Appl Sci 5((4 part (2))):1–5

    Google Scholar 

  7. Zhao Z, Sun H, Zeng T et al (2020) An easy risk stratification to recommend the optimal patients with 2–3 cm kidney stones to receive retrograde intrarenal surgery or mini-percutaneous nephrolithotomy. Urolithiasis 48(2):167–173

    Article  Google Scholar 

  8. Erkoc M, Bozkurt M (2021) Comparison of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for renal pelvic stones of 2–3 cm. J Laparoendosc Adv Surg Tech 31(6):605–609

    Article  Google Scholar 

  9. Zeng G, Cai C, Duan X et al (2021) Mini percutaneous nephrolithotomy is a noninferior modality to standard percutaneous nephrolithotomy for the management of 20–40 mm renal calculi: a multicenter randomized controlled trial. Eur Urol 79(1):114–121

    Article  Google Scholar 

  10. Niwa N, Matsumoto K, Ohigashi T et al (2019) Clinical outcomes of retrograde intrarenal surgery as a primary treatment for staghorn calculi: a single-center experience. Clin Med Insights: Urol 12:1179561119854772

    Google Scholar 

  11. Sanguedolce F, Bozzini G, Chew B et al (2017) The evolving role of retrograde intrarenal surgery in the treatment of urolithiasis. Eur Urol Focus 3(1):46–55

    Article  Google Scholar 

  12. Jiao B, Luo Z, Xu X et al (2019) Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in surgical management of upper urinary stones-A systematic review with meta-analysis. Int J Surg 71:1–11

    Article  Google Scholar 

  13. De S, Autorino R, Kim FJ et al (2015) Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol 67(1):125–137

    Article  Google Scholar 

  14. Abd El Hamed AM, Elmoghazy H, Aldahshoury M et al (2017) Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2–3 cm in diameter: does stone size or hardness play a role in number of sessions to be applied?”. Turk J Urol 43(2):158

    Article  Google Scholar 

  15. Resorlu B, Unsal A, Gulec H et al (2012) A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the “resorlu-unsal stone score.” Urology 80(3):512–518

    Article  Google Scholar 

  16. Forbes CM, Rebullar KA, Teichman JM (2018) Comparison of flexible ureteroscopy damage rates for lower pole renal stones by laser fiber type. Lasers Surg Med 50(8):798–801

    Article  Google Scholar 

  17. Becker B, Gross AJ, Netsch C (2019) Ho: YaG laser lithotripsy: recent innovations. Curr Opin Urol 29(2):103–107

    Article  Google Scholar 

  18. Elhilali MM, Badaan S, Ibrahim A et al (2017) Use of the Moses technology to improve holmium laser lithotripsy outcomes: a preclinical study. J Endourol 31(6):598–604

    Article  Google Scholar 

  19. Petzold R, Miernik A, Suarez-Ibarrola R (2021) In vitro dusting performance of a new solid-state thulium laser compared to holmium laser lithotripsy. J Endourol 35(2):221–225

    Article  Google Scholar 

  20. Cracco CM, Scoffone CM (2020) Endoscopic combined intrarenal surgery (ECIRS)-Tips and tricks to improve outcomes: a systematic review. Tur J Urol 46(Suppl 1):S46

    Article  Google Scholar 

  21. Lee JW, Park J, Lee SB et al (2015) Mini-percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger than 10 mm: a prospective randomized controlled trial. Urology 86(5):873–877

    Article  Google Scholar 

  22. Pan J, Chen Q, Xue W et al (2013) RIRS versus mPCNL for single renal stone of 2–3 cm: clinical outcome and cost-effective analysis in Chinese medical setting. Urolithiasis 41(1):73–78

    Article  Google Scholar 

  23. Hein S, Schoenthaler M, Wilhelm K et al (2017) Ultralow radiation exposure during flexible ureteroscopy in patients with nephrolithiasis—How far can we go? Urology 108:34–39

    Article  Google Scholar 

  24. Peng Y, Xu B, Zhang W et al (2015) Retrograde intrarenal surgery for the treatment of renal stones: is fluoroscopy-free technique achievable? Urolithiasis 43(3):265–270

    Article  Google Scholar 

  25. Cheng F, Yu W, Zhang X et al (2010) Minimally invasive tract in percutaneous nephrolithotomy for renal stones. J Endourol 24(10):1579–1582

    Article  Google Scholar 

  26. ElSheemy MS, Elmarakbi AA, Hytham M et al (2019) Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis 47(2):207–214

    Article  Google Scholar 

  27. Kim HY, Lee KW, Lee DS (2020) Critical causes in severe bleeding requiring angioembolization after percutaneous nephrolithotomy. BMC Urol 20(1):1–7

    Article  Google Scholar 

  28. Suh LK, Rothberg MB, Landman J et al (2010) Intrarenal pressures generated during deployment of various antiretropulsion devices in an ex vivo porcine model. J Endourol 24(7):1165–1168

    Article  Google Scholar 

Download references

Funding

No funding.

Author information

Authors and Affiliations

  1. Department of Urology, University of Health Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, 06380, Turkey

    Muhammed Arif Ibis

  2. Department of Urology, Ankara University School of Medicine, Ankara, Turkey

    Mehmet Ilker Gokce & Muammer Babayigit

  3. Department of Urology, Istinye University School of Medicine, Istanbul, Turkey

    Yasin Yitgin

  4. Department of Urology, University of Health Sciences, Cemil Tascıoglu City Hospital Training and Research Hospital, Prof. Dr, Istanbul, Turkey

    Mehmet Ali Karagoz

  5. Department of Urology, Private Istanbul Medivita Ethica Hospital, Istanbul, Turkey

    Abubekir Boyuk

  6. Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey

    Samed Verep

  7. Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Serdar Turan, Tzevat Tefik & Rifat Ergul

  8. Department of Urology, School of Medicine, Koc University, Istanbul, Turkey

    Murat Can Kiremit

  9. Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey

    Mehmet Giray Sonmez & Selcuk Guven

  10. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey

    Kemal Sarica

Authors
  1. Muhammed Arif Ibis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Ilker Gokce
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muammer Babayigit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasin Yitgin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mehmet Ali Karagoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abubekir Boyuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Samed Verep
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Serdar Turan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tzevat Tefik
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Murat Can Kiremit
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mehmet Giray Sonmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Rifat Ergul
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Selcuk Guven
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kemal Sarica
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MA: Ibis protocol/project development, data collection or management, data analysis, manuscript writing/editing; MB: data collection or management, data analysis, manuscript writing/editing; MIG: manuscript writing/editing; YY: data collection or management, manuscript writing/editing; MAK: manuscript writing/editing; AB: protocol/project development, manuscript writing/editing; SV: data collection or management, data analysis; ST: data collection or management, data analysis; TT: manuscript writing/editing; MCK: protocol/project development, data collection or management; MGS: data collection or management; RE: data collection or management, data analysis; SG: manuscript writing/editing; KS: protocol/project development, manuscript writing/editing. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Muhammed Arif Ibis.

Ethics declarations

Conflict of interest

The authors have no potential or financial conflicts of interest to declare.

Ethics approval

The study was approved by the Ankara University Faculty of Medicine Ethics Committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ibis, M.A., Gokce, M.I., Babayigit, M. et al. Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20–30 mm) stones? A critical evaluation. Int Urol Nephrol 54, 2141–2148 (2022). https://doi.org/10.1007/s11255-022-03255-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03255-9

Keywords

Search

Navigation