Comparative Outcomes of Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy in the Management of Renal Calculi: A Study of 120 Cases

Background: Renal calculi represent a significant urological burden globally, affecting up to 10% of the population and demonstrating increasing prevalence. Management strategies have evolved from open surgery to minimally invasive techniques. Retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are two widely adopted minimally invasive procedures. While both are effective, differences in efficacy, safety, complication profile, and resource utilization persist.

Objective: To compare the clinical outcomes, safety, efficacy, and perioperative parameters of RIRS and PCNL in treating renal calculi in a cohort of 120 patients.

Methods: This prospective comparative study included 120 patients diagnosed with renal stones between July 2023 to June 2025. Patients were randomized into two groups: Group A (RIRS; n = 60) and Group B (PCNL; n = 60). Key endpoints included stone-free rate (SFR), operative time, hospital stay, analgesic requirement, and complications classified by Clavien-Dindo.

Results: The overall SFR at 3 months was 85% for RIRS and 92% for PCNL (p = 0.21). PCNL demonstrated a higher SFR for stones >2 cm (p < 0.05). RIRS showed shorter operative time, reduced analgesic requirement, and shorter hospital stay (p < 0.01). Complications were more frequent in PCNL, notably bleeding requiring transfusion (5%) compared to RIRS (0%). Minor complications (fever, transient hematuria) were comparable. No mortalities were observed.

Conclusion: Both RIRS and PCNL are effective for renal calculi. PCNL achieves higher SFR for larger stones, while RIRS offers advantages in terms of hospital stay, pain profile, and complication rates. Tailored treatment selection based on stone burden, patient comorbidity, and resource availability is recommended.

Keywords: Retrograde Intrarenal Surgery (RIRS), Percutaneous Nephrolithotomy (PCNL), Renal Calculi, Stone-Free Rate, Minimally Invasive Urology.