Does prior PCNL affect RIRS? A retrospective analysis of a single center data.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Treatment

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stones.
• Evaluating alternative or sequential treatments like retrograde intrarenal surgery (RIRS) is crucial for managing complex or recurrent stone cases.
• Understanding the outcomes of RIRS following prior PCNL is essential for optimizing patient care.

Purpose of the Study:

• To compare the outcomes and safety of retrograde intrarenal surgery (RIRS) in patients with a history of percutaneous nephrolithotomy (PCNL) versus primary RIRS.
• To assess the impact of prior PCNL on operative parameters, stone-free status, and complication rates during subsequent RIRS procedures.

Main Methods:

• Retrospective analysis of 231 patients undergoing RIRS after PCNL (Group 2) and 396 patients undergoing primary RIRS (Group 1) between August 2018 and April 2023.
• Evaluation of preoperative characteristics, stone burden, operative details (operation time, fluoroscopy time), stone-free status (SFS), and complications.
• Statistical comparison using Student's t test, Mann-Whitney U test, and Pearson Chi-square test.

Main Results:

• No significant differences in age, BMI, stone number, stone burden, or stone-free status between groups.
• Significantly longer operation times (81.32 min vs 65.23 min) and fluoroscopy times (46.61 s vs 26.34 s) in the RIRS-after-PCNL group (p<0.05).
• Similar complication rates (12% vs 14%) and incidence of infundibulum stenosis (12% in Group 2).

Conclusions:

• Prior PCNL is associated with increased operative time and fluoroscopy exposure during subsequent RIRS.
• RIRS remains a safe and effective treatment option following PCNL, with comparable stone-free rates and complication profiles.
• These findings support careful patient selection and surgical planning for RIRS in patients with a history of PCNL.