Mini- Percutaneous Nephrolithotomy, Retro-grade Intra-renal Surgery, and Extra-corporeal ShockWave Lithotripsy for Treatment of Mediumsized, HighDensity, NonLower Pole, Renal Stones: A Prospective, Randomized, Comparative Study

Background : Treatment options for medium in size renal stones, including shockwave litho-tripsy (SWL), flexible intra-renal (RIRS), and percutaneous nephrolithotomy (PNL), remain debated. Aim: The current study contrasts between the efficacy of mini-PNL, RIRS, and SWL in the management of high in density renal stones. Methods: This randomly allocated, prospective trial involved 247 individuals with single stone that is not lower calcyeal (between 1 and 2 cm) and a density of ≥1000 Hounsfield Unit. The individuals were randomly assigned to undergo mini-PNL (no.= 82), RIRS (no.= 84), or SWL (no.= 81). stone-free rate (SFR) was the primary endpoint, while operation time, fluoroscopy time, hospital stay, and complications were considered as secondary endpoints. Results: Analysis finally comprised 82 individuals in the mini-PNL section, 84 in the RIRS section, and 81 in the SWL section. The median age was 39 y, the median BMI was 26.9. The highest SFR was observed in the mini-PNL section (95.1%), followed by RIRS (90.5%) and SWL (33.3%). SFR was far greater in mini-PNL and RIRS sections than SWL (p < 0.001). The SWL section had the shortest operative time, while RIRS exhibited the lowest fluoroscopy time (p < 0.001). Complication rate was highest in the RIRS section (46.4%), followed by mini-PNL (22.0%) and SWL (17.3%). Conclusion: Mini-PNL and RIRS are significantly more effective than SWL in the management of renal stones that are medium in size, high in density, and not in lower pole. Mini-PNL provides highest single-session SFR, while RIRS minimizes fluoroscopy exposure and hospital stay. Treatment selection should be individualised based on patient factors and institinfected urinary systemonal resources.