Treating renal calculi 1-2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study

Study Type – Therapy (pattern of practice survey) Level of Evidence 2b What's known on the subject? and What does the study add? Miniperc and RIRS are commonly used modality for treating non-bulky renal urolithiasis. Both the treatment options are invasive and are associated with inherent complications. There are only a few studies that compare these two treatment modalities. Both the modalities are effective to render patient stone free with minimal complications. Immediate stone free rate is higher with miniperc but comparable in both the modalities at 1 month. RIRS is associated with favourable pain scores and lower hemoglobin drop. OBJECTIVE • To plan a prospective comparative case–control designed study aiming to compare minipercutaneous (miniperc) and retrograde intrarenal surgery (RIRS) for a renal calculus of size 1–2 cm. PATIENTS AND METHODS • A total of 64 cases (32 in each arm) underwent miniperc and RIRS during the study period from March 2009 to April 2011. • The primary and secondary outcome objective was stone-free rate and retreatment rate, complications, operation duration, patient visual pain scores, analgesic requirement, haemoglobin drop and hospital stay, respectively. RESULTS • Miniperc and RIRS had stone clearance rates of 100% and 96.88%, respectively. • In the RIRS group, one patient required retreatment at 1 month. • Hospital stay (0.24) and intra-operative (0.99) and postoperative complications (0.60) were similar in both groups. • Operation duration (P= 0.003) was lower in the miniperc group. • Haemoglobin drop (P < 0.001), patient pain and visual analogue scale score (each P < 0.001) at 6, 24 and 48 h, as well as analgesic requirement (P < 0.003), were all lower in the RIRS group. CONCLUSIONS • The stone clearances in both modalities are high and complications are low. • RIRS requires a larger operation duration, although it is associated with favourable pain scores and a lower haemoglobin drop.