#0947

Clinical Outcomes of Mini-Percutaneous Nephrolithotomy (mini-PCNL) and Retrograde Intrarenal Surgery (RIRS) for the Management of Large Renal Stones: A Meta-Analysis

R. Buxani¹, J. Ursua¹

¹East Avenue Medical Center, Urology, Quezon City, Philippines

Introduction:

Urinary tract stones are a common problem affecting humans and its incidence has increased significantly over the last decades. They are considered to be the most common cause of morbidity worldwide and the risk for developing stones is around 5 to 10%. Renal stones are generally recurrent in most cases of patients with a lifetime recurrence of 50%. While Percutaneous nephrolithotomy is effective in addressing complications, minimizing the size of the instrument could further reduce complications associated with the procedure. The advancement of technology has improved further the management for stone diseases. The development of retrograde intrarenal surgery (RIRS), a minimally invasive procedure has paved the way for better outcome with higher clearance rates.

Material and methods:

The researcher employed a meta-analytical assessment. The studies included were Ghazala et.al., (2021), Lee et.al., (2015) and Li et.al., (2018). The main proponent compared mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS). Baseline characteristics of patients were collected specifically age, sex, laterality and stone size. Clinical outcome of patients was also determined. This included mean operative time, use of JJ stent, stone free rate, mean hospital stay, and incidence of complications.

Results:

The highest mean age in the MPCNL group was 59. 3 years, and in the RIRS group was 55. 8 years, both reported by Lee et al. (2015). The age difference between groups was not statistically significant (p = . 460). A total of 124 male patients were studied, with 77 in MPCNL and 76 in RIRS, showing no significant difference between groups (p = . 510). Stone laterality showed equal distribution in the right kidney (n=78) for both groups; however, no significant difference was found (p = . 680). The RIRS group had a larger number of left kidney stones (n=98) compared to the MPCNL group (n=90). Still, this difference was not statistically significant (p = . 680). The mean stone size was larger in the MPCNL group (25. 47 mm) compared to RIRS (21. 26 mm), but no significant difference was observed (p = . 380). Operative time was longer for RIRS patients (66. 56 minutes) versus MPCNL patients (57. 58 minutes), yet this was also not statistically significant (p = . 290). The stone-free rate was higher in RIRS patients (155) compared to MPCNL (153), with no significant difference (p = . 350). Higher rates of stent placement were noted in the RIRS group (n=54) versus MPCNL (n=45), and the difference was significant (p = . 010). Patients undergoing MPCNL had a longer mean hospital stay (18. 20 days) compared to those in RIRS (9. 20 days), with statistically significant results (p = . 001). Complications were more frequent in the RIRS group (n=18) compared to the MPCNL group (n=15), but this difference was not statistically significant (p = . 480).