For patients with medium-sized kidney stones (1-3 cm), two common surgical options are retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL). A meta-analysis of 4173 patients compared these procedures head-to-head.
The main finding is that mPCNL achieves a higher stone-free rate in a single session. About 92% of patients were stone-free after one mPCNL session compared to RIRS. This difference was statistically significant and confirmed by a trial sequential analysis, meaning the evidence is strong.
However, RIRS has advantages in safety and recovery. Patients undergoing RIRS had fewer blood transfusions, smaller drops in hemoglobin, and shorter hospital stays. The overall complication rate was also lower with RIRS, though this difference did not reach statistical significance. Serious complications (grade III-V) were similar between the two procedures.
On the downside, RIRS patients were more likely to need additional procedures after surgery to clear remaining stones. Operative times were similar for both techniques.
The choice between these procedures should be personalized. For patients who prioritize a single procedure to clear the stone, mPCNL may be better. For those who want a less invasive option with faster recovery, RIRS could be preferred.