Comparison of effectiveness and safety between tubeless percutaneous nephrolithotomy and negative pressure combined with retrograde intrarenal surgery for 2 to 3 cm renal stones

Our study aimed to analyzed the effectiveness and safety of tubeless mini percutaneous nephrolithotomy (tmPCNL) and negative pressure combined with retrograde intrarenal surgery (nRIRS) for 2 to 3 cm renal stones. A total of 557 patients underwent tmPCNL or nRIRS for renal stones in our department from October 2022 to February 2024. Combining inclusion and exclusion criteria, 153 cases were included and divided into tmPCNL group (n = 76) and nRIRS group (n = 77) according to the surgical method. Retrospective analysis of data from 2 groups of patients, such as age, gender, stone characteristics, renal function, previous surgical history, postoperative effects, and perioperative complications. There was no statistically significant difference in baseline data between the 2 groups, such as age, gender, body mass index, comorbidities, stone length, stone side, number of stones, stones density, hydronephrosis, and preoperative urine bacterial culture. The surgical time and postoperative hemoglobin decrease were 58.43 ± 17.22 versus 74.86 ± 29.35 (P = .002), 8.84 ± 6.75 versus 6.83 ± 6.06 (P = .002). In addition, in terms of visual analogue scale, the nRIRS group was lower than the tmPCNL group, with 2 (2,4) versus 2 (1,2; P < .001). Seven patients in tmPCNL group developed infections, of which 6 fever and 1 sepsis. Three patients in the nRIRS group experienced fever and no sepsis. The stone-free rate of the nRIRS group was higher than that of the tmPCNL group on first month after surgery, but there was no statistical difference. Average surgical steps in the tmPCNL group and nRIRS group were 1.039 versus 1.020 times (P = .305). For 2 to 3 cm renal stones, the stone-free rate, hospital stay and postoperative infection complications of tmPCNL and nRIRS were similar. tmPCNL had shorter surgical time, but nRIRS was superior to tmPCNL in terms of postoperative pain, hemoglobin decrease.