Prospective study on Comparison of outcomes of mini percutaneous nephrolithotomy versus retrograde intrarenal surgery for renal stones of 1–2 cm size

AIM AND OBJECTIVES: The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate. MATERIALS AND METHODS: This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi. INCLUSION CRITERIA: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020. Age >15 years. EXCLUSION CRITERIA: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal system. Pregnant women. RESULTS: The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance. CONCLUSION: The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups.