Preoperative anxiety in patients undergoing RIRS and PCNL: a prospective comparative study

Data directly comparing preoperative anxiety between contemporary endourological stone procedures while accounting for differences in stone burden and other baseline clinical characteristics are limited. In this prospective observational cohort study, we aimed to compare anxiety levels in patients undergoing retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) and to explore factors associated with preoperative anxiety. A total of 120 patients undergoing RIRS ( n = 60) or PCNL ( n = 60) for renal stones were prospectively enrolled. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State Anxiety subscale of the State–Trait Anxiety Inventory (STAI-S). Multivariable linear regression analyses were performed adjusting for log-transformed stone volume, ASA physical status, age, and sex. Anxiety scores were significantly higher in the PCNL group (APAIS: 18.68 ± 3.33 vs. 13.27 ± 6.15; STAI-S: 44.80 ± 6.53 vs. 32.18 ± 7.06; p < 0.01 for both). In multivariable linear regression analyses, PCNL remained associated with higher STAI-S (B = 14.33, 95% CI 8.69–19.96, p < 0.001) and APAIS scores (B = 4.93, 95% CI 0.92–8.95, p = 0.016). Elevated state anxiety (STAI-S ≥ 40) was observed in 78.3% of patients in the PCNL group compared with 10.0% in the RIRS group ( p < 0.001). PCNL is associated with higher preoperative anxiety; however, this difference may be influenced by greater procedural invasiveness and underlying disease burden rather than the surgical approach alone. Structured preoperative anxiety assessment may be particularly important in patients scheduled for more invasive stone surgery. ClinicalTrials.gov, NCT07772830. Retrospectively registered on 14 August 2026.