Is retrograde intrarenal surgery a safer and more efficient alternative treatment to percutaneous nephrolithotomy in terms of higher stone-free rates and shorter hospital stay among adults with kidney stones 20 mm or greater?

Abstract

This review aims to evaluate whether retrograde intrarenal surgery (RIRS) is a safe and efficient alternative treatment to percutaneous nephrolithotomy (PCNL) for stones 20 mm or greater in terms of stone-free rate (SFR) and shorter hospital stay due to lower complications. Research conducted in the years 2007–2017 was considered relevant. Numerous search engines were used to acquire the eight papers included in this meta-analysis. From the eight key papers that were considered, one was a meta-analysis, one was a prospective clinical controlled trial (CCT), and the other six were retrospective CCTs. All studies found higher SFRs in PCNL but the difference was statistically significant in only two of the included studies. This improvement was not reported in any of the studies, including the meta-analysis. As a result, this reflects an inconsistency in the evidence produced. When evaluating hospital stay, all researchers found a statistically significantly shorter stay in the RIRS group compared to the PCNL group, this being potentially attributed to higher rates in minor complications. Due to the inconsistencies evaluated from the key papers, it was concluded that study results ought to be interpreted with caution. RIRS seems to be a safe and effective surgical procedure for selected patients as RIRS offers a comparable initial SFR success as PCNL. This is a cautious statement, drawn in view of inconsistent evidence regarding its superiority over PCNL in this regard. Furthermore, consistent evidence is available, demonstrating its ability to significantly reduce hospital stay without increasing complications. Therefore, RIRS may be considered an alternative to PCNL in selected patients. With that being said, more research is required on this evaluation given that a definite conclusion cannot be reached.