Ahmed H. ABDELGAWAD, Mamdouh A. ELHAWY, Al Ayman Hussein Fathy HUSSEIN, Tarek KH. FATHELBAB, Amr Kamal Rabea TOLBA, Ahmed Mohamed FAWZY
Urology Research & Practice - 2025;51(6):230-236
Objective: Retrograde intrarenal surgery (RIRS) is the first-line treatment for kidney stones between 1 and 2 cm and can serve as an alternative to percutaneous nephrolithotomy for larger stones in high-risk patients, including those with bleeding disorders, obesity, renal congenital abnormalities, or solitary kidneys. We aimed to compare the safety and efficacy of supine mini-percutaneous nephrolithotomy (PCNL) versus RIRS for the treatment of renal pelvic stones less than 2 cm. Methods: This prospective, randomized, double-blinded study included 50 patients aged >18 years, of both sexes, with renal stones <2 cm. Patients were randomized into 2 equal groups: Group A underwent supine mini-PCNL, while Group B underwent RIRS. Stone and patient characteristics, SFR, and perioperative events were compared between groups. Results: A total of 50 patients equally distributed into the 2 groups. Operative time was significantly lower in Group A than in Group B (P < .05), while fluoroscopic time was significantly higher in Group A than in Group B (P < .05). Also, hospital stay was significantly longer in Group A compared to Group B (P < .001). SFR and retreatments were comparable between both groups. Complications were also similar, with no significant differences observed. Conclusions: Supine mini-PCNL remains an effective option for achieving high stone clearance with a shorter operative time while avoiding ureteral access manipulation, while RIRS provides advantages such as reduced radiation exposure, shorter hospitalization but with a higher need for stenting and secondary procedures. Supine mini-PCNL is not inferior to RIRS in the treatment of less than 2 cm renal stones.
