TO COMPARE THE OUTCOMES OF RETROGRADE INTRARENAL SURGERY (RIRS) WITH PERCUTANEOUS NEPHROLITHOTOMY FOR THE TREATMENT OF RENAL STONES > 20 MM.

Introduction: Retrograde intrarenal surgery (RIRS) performed using a flexible or semi rigid uretero renoscope marked the beginning of a new era in urology. Percutaneous nephrolithotomy is a standard treatment for larger stones with very good success rates but at the eve of high levels of patient’s morbidity. It may be associated with Grade IV renal trauma. While RIRS is associated with minimal morbidity.

Objective: To compare the outcomes of retrograde intrarenal surgery (RIRS) with percutaneous nephrolithotomy for the treatment of renal stones > 20 mm.

Study Design: Randomized Clinical Trial.

Setting: The study was conducted for 6 months at department of Urology, Sindh Institute of Urology and Transplantation (SIUT) Karachi since 1st-April-2017 to 30th-September-2017.

Materials and Methods: A total number of 136 patients with diagnosis of kidney stones (stone size > 20 mm) were included in this analysis. Patients were randomly divided into two groups using lottery method. Group I: Patients underwent percutaneous nephrolithotomy and Group II patients underwent RIRS for the treatment of renal stones. Post-procedural X-ray KUB was done 2 weeks after the surgical procedure to determine the stone clearance in every patient. Mean hemoglobin drop and hospital stay time was noted for every patient.

Data analysis was carried out using SPSS v20.0. Independent sample t-test was used to compare the hospital stay and hemoglobin drop between the groups. While chi-square test was used to compare stone clearance rate between groups.

Results: The mean age of the patients in this study was 44.98+10.68 years. . There were 90 (66.18%) male patients and 46 (33.82%) female patients. Mean size of renal stones was 29.5+6.3 mm. stone clearance was 64 (94.1%) in patients who underwent PCNL procedure while stone clearance rate was 59 (86.8%) in RIRS patients (p-value 0.14). Mean reduction in hemoglobin levels was 2.24+0.52 g/dl in PCNL group and 1.92+0.57 g/dl in RIRS group (p-value 0.001). Mean hospital stay was 1.55+0.60 days in RIRS group versus 2.60+0.71 days in PCNL patients (p-value <0.001).

Conclusion: RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PCNL when larger stones are to be treated.

Keywords: Renal Stones, Retrograde Intrarenal Surgery, Percutaneous nephrolithotomy.