A PROSPECTIVE STUDY COMPARING TUBELESS MINI-PERCUTANEOUS NEPHROLITHOTOMY TO RETROGRADE INTRARENAL SURGERY FOR ≤2 CM RENAL STONES.

Abstract

Objective:

The present study aims to assess the safety and efficacy of tubeless mini-PCNL and RIRS in the management of renal stones of ⩽2 cm size.

Patients and methods:

This was a prospective study in 80 patients with renal stones of ⩽2 cm and were divided into two equal groups of patients choice: Group 1 were managed by tubeless mini-PCNL and Group 2 by RIRS using flexible ureteroscopy and laser. Intraoperative events like duration of surgery, stone clearance and complications were noted. Postoperative parameters taken into account were pain score, parenteral analgesic requirements, bleeding, need for blood transfusion, fever, hospital stay, cost of the procedure and number of days taken to return to normal work.

Results:

Both groups were comparable for preoperative parameters. Mean duration of surgery in group 1 and group 2 was 68.88 ± 7.20 minutes and 92.25 ± 14.62 minutes respectively (p<0.00001). The mean haemoglobin fall in group 1 and group 2 was 0.47±0.24 g/dl and in group 2 was 0.28±0.18 g/dl respectively (p=0.00013). In group 2, residual stones were present in 4 patients (on follow-up at 3 weeks), while in group 1 there was no residual stones. The cost of the treatment was more in the RIRS group with statistically significant difference (p<0.005).

Conclusion:

In a urological setup where LASER and flexible ureteroscope are not available, tubeless mini PCNL is a safe, efficacious and cost-effective option for the management of smaller (⩽ 2 cm) stones compared to RIRS procedure.

Recommendations:

Mini PCNL and RIRS are safe and feasible surgical options to manage ⩽ 2 cm renal stones. We recommend tubeless mini PCNL in a setup where LASER and flexible ureteroscope are not available.