Outcomes of different minimally invasive techniques in lower calyceal stones of 1 to 2 centimeters: A prospective,...

To compare efficiency, safety and full cost of lower retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) types for the treatment of lower calyceal stones between 1 and 2 cm in size.

This was a prospective, randomized study. In all, 175 patients were randomly divided into five groups of 35 patients each: Group A was managed by RIRS, Group B by micro PNL, Group C by ultra-mini PNL, Group D by mini PNL, and Group E by standard PNL. Operating and fluoroscopy time, length of hospital stay, stone-free rates (SFR), complications, secondar y ureterolithotripsy and cost were compared between groups. RESULTS: A total of 168 patients were included in the final analysis. The SFR was 76%, 77%, 90.1%, 94.1% and 94%; median length of hospital stay 1, 1.5, 2, 2, and 3 days was for RIRS, micro, ultra-mini, mini, and standard PNL, respectively (p<0.001). The mean costs of the procedures per case were $1,250, $962,$695, $632, and $619, and the mean return to daily activities time was 3.9, 4.5, 6.5, 9.3, and 13.5 days for RIRS, micro, ultra-mini, mini,and standard PNL, respectively (p<0.001).

SFR of treatment of lower calyceal stone was higher in ultra-mini, mini and standard PNL than micro PNL and RIRS. Moreover, patients should be informed about the results of all different procedures ; with increasing of the invasiveness of treatment, cost of the procedure decrease; but the hospital stay and return to daily activity interval increase.