Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy in the Treatment of 2-3 cm Multicalyceal Kidney Stones

Amaç: Retrograd intrarenal cerrahi (RIRC) gelişen teknolojiyle beraber kullanımı yaygınlaşmakta olan bir yöntemdir. 2 cm’den büyük boyutlu böbrek taşı tedavisinde önerilen ilk yöntem olan perkütan nefrolitotomide (PNL) yüksek başarı oranlarına rağmen hayatı tehdit edebilen komplikasyonlar görülebilmektedir. Anestezi açısından riskli olan, kanama bozukluğu olan, vücut bütünlüğü anatomik olarak PNL’ye uygun olmayan hastalarda veya Objective: To demonstrate the feasibility of retrograde intrarenal surgery (RIRS) in the treatment of 2-3 cm multicalyceal kidney stones considering the possible complications and unsuitable situations. Multiple kidney stones are observed among 20-25% of patients seen in urology clinics. Percutaneous nephrolithotomy (PNL) is the primary method for treating kidney stones larger than 2 cm. Despite the high success rate achieved, life-threatening complications associated with PNL may arise. Multiple accesses may be required for multiple stones. RIRS has become increasingly widely used. In our study, we aimed to compare these two methods in the treatment of 2-3 cm multicalyceal stones. Materials and Methods: We retrospectively evaluated data of patients who presented with multicalyceal kidney stones measuring 2-3 cm between 2012 and 2016. A total of 64 patients who underwent surgery (36 RIRS, 28 PNL) were included in the study. Results: Major complications were more common, operative time, fluoroscopy time and length of hospital stay time were longer in PNL group than in RIRS group. The number of stones was statistically higher in RIRS group. There was no statistically significant difference in other parameters. No statistically significant difference was found between the two groups in operation success rates. Conclusion: In the literature, the primary treatment option for 2-3 cm multicalyceal stones has been reported to be PNL. RIRS should be used in appropriate patients who have risks of complications related to anesthesia, bleeding disorder and patients with anatomic abnormalities who are not suitable for PNL. This method is also used to reduce the potential complications and it is more reliable.