Prospective Comparative Evaluation of Stone Clearance and Complications in Renal Stones Measuring 2 to 3.5 Centimeters: Percutaneous Nephrolithotomy (PCNL) versus Retrograde Intrarenal Surgery (RIRS)

Background Percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are the two most commonly used minimally invasive surgical techniques for renal stone disease, which is a major worldwide health burden. Because it is less intrusive, RIRS has become more common even though PCNL is still the gold standard for big renal stones. Clinical decision-making regarding the best intervention requires the use of comparative evidence. Objective To evaluate the perioperative results and stone-free rates of PCNL and RIRS in patients with kidney stones. Methodology In this prospective randomized controlled trial, patients with kidney stones (2-3.5 cm; n=440) were split evenly between two groups: PCNL (n=220) and RIRS (n=220). The following outcomes were evaluated: perioperative problems, hospital stay, operation time, stone-free rate, and auxiliary procedures. Independent t-tests for continuous variables and chi-square tests for categorical variables were used in the statistical analysis; p<0.05 was deemed significant. Results The PCNL group had a significantly higher stone-free rate than the RIRS group (90.0% vs. 80.0%, χ²=8.57, p=0.003). The mean operative time was longer in the PCNL group compared to RIRS (92.4 ± 18.5 vs. 78.6 ± 15.3 min, t=8.42, p<0.001). The mean hospital stay was also longer for PCNL (3.6 ± 1.2 vs. 1.8 ± 0.7 days, t=18.7, p<0.001). Patients undergoing PCNL experienced greater intraoperative bleeding (17.3% vs. 2.7%, χ²=26.9, p<0.001) and a higher mean hemoglobin drop (1.6 ± 0.8 vs. 0.7 ± 0.5 g/dl, t=13.1, p<0.001). Auxiliary procedure rates were higher in the RIRS group (20.0% vs. 10.0%, χ²=8.57, p=0.003). Conclusion Although PCNL provides better stone removal than RIRS, it is linked to longer operating times, longer hospital stays, and higher incidence of complications. Individualized treatment should be chosen according to the patient's and the stone's characteristics.