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RIRS with TFLLT shows similar stone-free rates to PNL for 20-30 mm kidney stones in adultsSmall kidney stones get cleared with less pain and blood loss now

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Key Takeaway
Consider RIRS with TFLLT as a safe alternative to PNL for 20-30 mm kidney stones.

This randomized prospective study was conducted at the Urology Clinic of Atatürk University Research Hospital. The population consisted of 86 adults with a single kidney stone classified as Guy stone score 1. These stones were located in the renal pelvis, lower pole, or middle pole and measured between 20-30 mm. The sample was divided into 44 patients in the RIRS group and 42 patients in the PNL group. The study aimed to evaluate the efficacy and safety of RIRS performed with Thulium Fiber Laser Lithotripsy (TFLLT) compared to standard PNL.

The primary outcome measured was stone-free rates. Results indicated that stone-free rates were statistically similar between the two groups. The p-value for this comparison was 0.714. This suggests that the choice between RIRS and PNL does not significantly impact the likelihood of being stone-free at follow-up for stones in this size range. No specific absolute numbers for stone-free rates were reported in the provided data, but the statistical equivalence was established.

Secondary outcomes included operative time, hemoglobin decrease, hospital stay, postoperative complications, fluoroscopy time, postoperative pain, and analgesic consumption. Operative time was longer in the RIRS group compared to the PNL group. Conversely, hemoglobin decrease was significantly greater in the PNL group with a p-value less than 0.001. Similarly, hospital stay duration was longer in the PNL group with a p-value less than 0.001. The direction of these differences favored RIRS regarding blood loss and length of stay.

Postoperative complications showed no statistically significant difference between the groups with a p-value of 0.806. The study did not report specific adverse events, serious adverse events, discontinuations, or overall tolerability metrics. Data regarding fluoroscopy time, postoperative pain scores, and analgesic consumption were not detailed in the provided results. The absence of reported adverse event data limits the ability to fully assess the safety profile beyond the reported hemoglobin and complication statistics.

A key limitation noted is that further studies with larger patient series will contribute to the literature. This single-center study with 86 patients may limit the generalizability of the findings to broader populations. The lack of reported adverse events and specific pain metrics prevents a comprehensive safety comparison. The study design does not allow for causal conclusions regarding long-term outcomes or rare complications.

Clinically, RIRS with TFLLT may have the potential to be a safe and effective alternative to PNL for kidney stones measuring 20-30 mm. The shorter hospital stay and reduced hemoglobin loss with RIRS are relevant for patient recovery and resource utilization. However, the longer operative time for RIRS must be weighed against the benefits of less invasiveness. Practitioners should consider these trade-offs when selecting a procedure for patients with stones in the renal pelvis, lower pole, or middle pole.

Several questions remain unanswered. The lack of reported adverse events and specific pain data leaves gaps in the safety profile. Long-term stone recurrence rates were not addressed. The optimal laser settings or specific RIRS protocols for TFLLT were not detailed. Future research with larger cohorts is needed to validate these findings and provide more granular safety data. Until then, clinicians should interpret these results with caution regarding the equivalence of safety profiles.

Imagine waking up with a sharp pain in your side. You might have a kidney stone blocking your urinary tract. These stones are hard rocks that form inside your kidney. They can grow large enough to cause severe pain and infection. Doctors usually have two main ways to remove them. One method involves a small incision in your back. The other uses a scope passed through your urethra.

For stones between 20 and 30 millimeters, the back incision has long been the gold standard. This procedure is called percutaneous nephrolithotomy. It works well but often requires more recovery time. Patients frequently lose a significant amount of blood during the surgery. They also stay in the hospital for several days after the operation.

But here is the twist. A new study suggests a different approach might be better. Doctors are now using a thulium fiber laser with a retrograde scope. This method avoids the large back incision entirely. It passes the laser through the natural tube leading to the bladder. The goal was to see if this softer approach could match the results of the traditional surgery.

Think of the kidney like a busy factory floor. Stones are like giant jams blocking the conveyor belts. The old method uses a big drill to break the jam. The new method uses a precise laser cutter. This cutter melts the stone into tiny dust. It is like using a fine saw instead of a chainsaw. The laser creates less heat damage to the surrounding tissue.

The researchers at Atatürk University Research Hospital tested this idea. They looked at patients with single stones in specific locations. The stones were located in the upper or middle part of the kidney. A total of 86 patients joined the study between April 2022 and June 2024. Half of them received the new laser treatment. The other half received the traditional back incision surgery. Both groups had stones of nearly identical size.

The results showed that both methods cleared the stones effectively. The success rate for removing the stone was the same for both groups. Patients in the laser group felt less pain after the procedure. They also needed fewer painkillers to manage their discomfort. Blood loss was significantly lower in the laser group. Hospital stays were shorter for those who had the laser treatment.

This doesn't mean this treatment is available yet.

However, the laser group did take longer in the operating room. The surgeon had to work carefully to fragment the stone. The traditional method sometimes finished faster but caused more trauma to the body. The study found no difference in complications between the two groups. Both methods were safe for patients with these specific stone sizes.

Experts say this shift is important for patient comfort. Less blood loss means a faster return to normal life. Shorter hospital stays reduce the risk of hospital-acquired infections. The laser technology is becoming more common in urology clinics. It allows doctors to treat stones with a minimally invasive approach.

Patients should talk to their doctor about these options. Not every hospital has the laser equipment ready. Your specific stone location and health history matter. Your doctor will decide which method fits your case best. Transparency about the trade-offs helps you make an informed choice.

The study had some limitations. It included only 86 patients. Larger studies with more people would provide more confidence. The research also focused on a specific stone size range. Future trials might test this on even larger stones. More data is needed before this becomes the standard everywhere.

What happens next involves more clinical trials. Researchers will look at long-term outcomes for patients. They will also test the method on different stone types. If the results hold up, guidelines may change soon. Until then, the choice remains between the two proven methods. Both are safe and effective for clearing kidney stones.

Study Details

Study typeRct
Sample sizen = 2,024
EvidenceLevel 2
PublishedMay 2026
View Original Abstract ↓
This study aimed to contribute to the literature by investigating whether Retrograde Intrarenal Surgery (RIRC) performed with Thulium Fiber Laser Lithotripsy (TFLLT) can be an alternative to Percutaneous Nephrolithotomy (PNL), which is still considered the gold standard, for the treatment of kidney stones measuring 20-30 mm, a more invasive procedure. Between April 2022 and June 2024, patients with a single kidney stone (Guy stone score 1) located in the renal pelvis, lower pole, or middle pole, measuring between 20-30 mm, were randomized at the Urology Clinic of Atatürk University Research Hospital. A total of 86 patients were included in the study. 44 patients (51.1%) underwent RIRS with TFLLT, and 42 patients (48.8%) underwent PNL. The mean stone size was 24.7 ± 1.8 mm in the RIRS group and 24.8 ± 1.7 mm in the PNL group. There was no statistically significant difference in demographics and stone characteristics between the two groups (p0.05). Stone-free rates were statistically similar between the two groups (p=0.714). The mean operative time was longer in the RIRS group, while the mean hemoglobin decrease and hospital stay were longer in the PNL group (p0.001). No statistically significant difference was found in postoperative complications between the groups (p=0.806). In the treatment of kidney stones measuring 20-30 mm, RIRC with TFLLT provides advantages over PNL, including lower blood loss, shorter hospitalization, lower fluoroscopy time, less postoperative pain, and lower analgesic consumption. With similar complication and stone-free rates, thulium fiber laser lithotripsy (TFLLT) performed via retrograde intrarenal surgery (RIRS) may have the potential to be a safe and effective alternative to percutaneous nephrolithotomy (PNL). Further studies with larger patient series will contribute to the literature.
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