Comparison of effectiveness of percutaneous nephrolithotomy versus retrograde intrarenal surgery


  • Srinivasrao P. Department of General Surgery, PESIMSR, Kuppam, Andhra Pradesh, India
  • Mallidu Shashidhar Department of General Surgery, PESIMSR, Kuppam, Andhra Pradesh, India



Kidney stones, Flexible ureteroscopy, PCNL, RIRS


Background: Treatment of renal stones depends upon the stone size, location, symptoms and any other anatomical variation in the calyceal system of the kidney. Percutaneous nephrolithotomy (PCNL) is a highly effective operation with consistently high stone-free rates; it delivers good stone clearance with minimal problems and a lower retreatment rate, while it is associated with higher morbidity. Retrograde intrarenal surgery (RIRS) is a less invasive and practical therapeutic option with a short hospital stay, minimal morbidity, and a low complication rate. Objectives were to compare the effectiveness of PCNL and RIRS in the treatment of renal stones.

Methods: 50 patients with renal stones with no comorbidities were divided into 2 groups. Group-1 was treated with PCNL, while group-2 underwent RIRS. The outcomes of both procedures were compared based on the operating time, duration of hospital stay and stone-free rate.

Results: The mean duration of hospital stay was higher in the PCNL group (4.37±2.11 days) than the RIRS group (2.84±0.98 days). The stone free rate was more in the PCNL group (96%) as compared to the RIRS group (84%). The PCNL group (78±12.75 minutes) had a longer operative time than the RIRS group (70.59±10.09 minutes. Blood loss was more in the PCNL group.

Conclusions: RIRS is an effective and safe alternative to PCNL in the treatment of renal stones. The choice of surgical approach between PCNL and RIRS should be based on the surgeon's experience and preference and the patient's financial means.


Thakore P, Liang TH. Urolithiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.

Romero V, Akpinar H, Assimos DG. Kidney stones: A global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12:e86-96.

Hesse A, Brandle E, Wilbert D, Kohrmann KU, Alken P. Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol. 2003;44:709-13.

Onal B, Citgez S, Tansu N, Emin G, Demirkesen O, Talat Z, et al. What changed in the management of pediatric stones after the introduction of minimally invasive procedures? A single-center experience over 24 years. J Pediatr Urol. 2013;9(6):910-4.

Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C. Guidelines on urolithiasis. Euro association of urol Update. 2011;5(3):26.

Karakoc O, Karakeci A, Ozan T, Firdolas F, Tektas C, Ozkaratas S, et al. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm. Türk Üroloji Dergisi/Turk J Urol. 2015;41(2):73-7.

Chung K, Kim J, Min G, Park H, Li S, Del Giudice F, et al. Changing Trends in the Treatment of Nephrolithiasis in the Real World. J Endourol. 2019;33(3):248-53.

Singh D. Comparison of Percutaneous Nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) for Management of Inferior Calyceal 1-2 cm Stones: A Matched Pair Analysis. J Med Sci Clin Res. 2018;6(6).

Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X, Jiang R. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta analysis. Experimental and Therapeutic Med. 2019;18(2):1366-74.

Kallidonis P, Ntasiotis P, Somani B, Adamou C, Emiliani E, Knoll T, et al. Systematic Review and Meta-Analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones Less Than 2 cm in Maximum Diameter. J Urol. 2020;204(3):427-33.

Wang F, Hong Y, Yang Z. Comparison of retrograde intrarenal surgery and standard percutaneous nephrolithotomy for management of stones at ureteropelvic junction with high-grade hydronephrosis. Sci Rep. 2021;11:14050.

Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol. 2013;31:1581-6.

Akman T, Binbay M, Yuruk E, Sari E, Seyrek M, Kaba M, et al. Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models. Urology. 2011;77:299-304.

Shah H, Khandkar A, Sodha H, Kharodawala S, Hegde S, Bansal M. Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int. 2009;104:840-6.

Garg D, Appu T, Georgie M, Balagopal N, Ginil K. Comparison Between Retrograde Intrarenal Surgery (RIRS) And Percutaneous Nephrolithotomy (PCNL) In the Treatment of Single Renal Stone 2-3 cm. J Evolution Med Dental Sci. 2015;4(59):10357-62.

Mami D, Alchinbayev M, Kazachenko A. Comparison of Minimally Invasive Treatment Methods for Urinary Stones: A Retrospective Analysis. Electronic J Gen Med. 2021;18(6):em321.

Syahputra F, Birowo P, Rasyid N, Matondang F, Noviandrini E, Huseini M. Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study. F1000Res. 2016;5:1550.






Original Research Articles