Miniperc and retrograde intrarenal surgery: when and how?

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Treatment

Background:

• Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL) are established kidney stone treatments.
• ESWL has lower efficacy for lower calyx stones, while PCNL involves significant morbidity.
• Innovations include miniaturized instruments and retrograde intrarenal surgery (RIRS).

Purpose of the Study:

• To compare the efficacy and complications of mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) for kidney stone treatment.
• To evaluate the current landscape of minimally invasive kidney stone procedures.

Main Methods:

• A structured, nonsystematic literature review was performed.
• Searched PubMed, Google Scholar, and Scopus databases for articles published between 1997 and 2013.
• Keywords included: kidney stones, miniperc, mini-PCNL, RIRS, and flexible ureteroscopy.

Main Results:

• Retrograde intrarenal surgery (RIRS) involves longer operative times, potential need for multiple procedures for large stones, and higher costs due to instrument fragility.
• Mini percutaneous nephrolithotomy (mini-PCNL) is associated with longer hospital stays, increased need for postoperative pain management, and greater hemoglobin reduction, though transfusion rates are not elevated.
• Both mini-PCNL and RIRS demonstrate equivalent stone clearance rates and minimal complications.

Conclusions:

• Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are current, minimally invasive options for kidney stone treatment.
• These procedures are comparable in efficacy and complication rates.
• Comparative prospective studies are essential to establish definitive roles; however, they are considered complementary techniques in urology.