COMPARISON OF MEAN OPERATIVE TIME IN PERCUTANEOUS NEPHROLITHOTOMY AND RETROGRADE INTRARENAL SURGERY FOR RENAL STONES >2 CM: A SINGLE-CENTER EXPERIENCE

Abstract

Background: Urolithiasis is a common condition with high prevalence in Pakistan, which lies in the Stone Belt. For renal stones larger than 2 cm, percutaneous nephrolithotomy (PCNL) has been the standard treatment, though retrograde intrarenal surgery (RIRS) has recently emerged as a minimally invasive alternative with advances in endourology.

Objectives: To compare operative time, stone clearance, hospital stay, transfusion requirements, and need for additional procedures between PCNL and RIRS in patients with renal stones >2 cm.

Study design: Cross-sectional study.

Settings & Study duration: Urology Department, PAF Hospital Islamabad from 18th February 2025 to 18th May 2025.

Methods: A total of 139 patients with renal stones >2 cm were included after informed consent and preoperative evaluation. Patients opted for either PCNL (Group 1) or RIRS (Group 2). Demographics, stone characteristics, operative time, hospital stay, hemoglobin drop, blood transfusion, stone clearance, ICU stay, and need for additional procedures were recorded on a structured proforma. Statistical analysis was performed using SPSS v23, with p ≤ 0.05 considered significant.

Results: Of 139 patients, 62 underwent PCNL and 77 underwent RIRS. Mean operative time was significantly lower in RIRS compared to PCNL (152.51 ± 36.46 vs 179.89 ± 45.56 min, p=0.0001). Hospital stay was also shorter in the RIRS group (2.30 ± 1.08 vs 2.69 ± 1.02 days, p=0.027). Stone clearance, need for additional procedures, and blood transfusion rates showed no statistically significant difference between groups.

Conclusion: RIRS offers significantly shorter operative time and hospital stay compared to PCNL for renal stones >2 cm, with comparable outcomes in terms of stone clearance and complication rates. It may be considered a minimally invasive alternative in selected patients.

Keywords: Urolithiasis, Percutaneous nephrolithotomy, Retrograde intrarenal surgery, Renal stones, Operative time