A comparative study of retrograde intrarenal surgery versus percutaneous nephrolithotomy for the management of staghorn renal calculi

Abstract

Abstract Background Due to the advancements in equipment and techniques, the indications for Retrograde IntraRenal Surgery (RIRS) have been expanded. However, there is limited research on the application of RIRS in the treatment of staghorn renal calculi. We aimed to compare the effectiveness and safety of RIRS and Percutaneous Nephrolithotomy (PCNL) as treatment modalities for staghorn renal calculi.Method We conducted a retrospective analysis of clinical data for all patients with staghorn renal calculi underwent treatment with either RIRS or PCNL at our hospital, and compared the perioperative outcomes and complications of the two groups.Results From April 2021 to March 2023, 47 patients underwent RIRS, while 45 patients underwent PCNL for the treatment of staghorn renal calculi. 1. There were no significant difference between the two groups in terms of number of complete staghorn calculi, stone size, mean number of surgery, total operative time. 2. RIRS was associated with shorter total hospitalization time(8.1 ± 8.4 VS 16 ± 8.7 days, p < 0.001) and postoperative hospitalization time(2.1 ± 0.8 VS 5.1 ± 2 days, p < 0.001). 3. RIRS showed less decrease in hemoglobin (1.92 ± 1.63 VS 8.99 ± 6.41 g/l, p < 0.001) and pain score (1.7 ± 0.7 VS 2.5 ± 1.1, p < 0.001). 4. RIRS demonstrated no significant difference in terms of 1 stage stone-free rate (51.1% VS 40%, p = 0.29) and total stone-free rate (78.3% VS 88.9%, p = 0.12), compared with PCNL. 5. The overall complication rate was lower in the RIRS group, with no significant difference (8.5% VS 15.6%, p = 0.30).Conclusion RIRS can reduce bleeding and overall complication, shorten hospitalization time, achieve satisfactory stone-free rates, when compared to PCNL. As a result, RIRS can be considered as an alternative treatment option for staghorn renal calculi.