Ultra mini percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones (1–3 cm): A prospective randomized comparative study

Abstract

Objective To compare the efficacy as well as the safety of Ultra Mini Percutaneous Nephrolithotomy (UM-PCNL) versus Retrograde Intrarenal Surgery (RIRS) using flexible ureteroscopy (F-URS) in the management of renal calculi between (1–3) cm in size.Patients and methods A total of 66 patients presenting with symptomatic renal stones 1–3 cm were recruited and allocated into two equal groups: Group A underwent Ultra mini PCNL (N = 33) while Group B underwent RIRS (N = 33).Results Clinical success was significantly higher after UM-PCNL than RIRS (93.9% vs 72.7%; absolute difference 21.2%, 95% CI 4.0–38.5%; p = 0.044). Operative time, hospital stay, and return to normal activity differed significantly (all p < 0.001); the mean total procedural cost was approximately three-fold higher in the RIRS group (43,625.04 vs 15,944.38 LE). Postoperative pain was slightly lower after RIRS (mean difference 0.33; 95% CI 0.04–0.62; p = 0.027), a clinically negligible difference. Retreatment (0% vs 12.1%; p = 0.114) and auxiliary procedures (6.1% vs 15.2%; p = 0.427) did not differ significantly. Complications occurred in 10 patients (30.3%) in Group A and 9 (27.3%) in Group B (p = 1.000); all were minor (Clavien–Dindo Grade I or II).Conclusions Ultra-mini PCNL is favored for higher stone clearance and a lower descriptive consumable and instrument cost in this setting, while RIRS is preferred when rapid recovery and shorter hospitalization are the priority. The observed difference in hospital stay partly reflects our institution’s post-PCNL protocol (approximately 48 h) and may not generalize to centers using early-discharge or ambulatory PCNL pathways. Treatment selection should be tailored to patient needs and circumstances.Registration (pactr.samrc.ac.za) PACTR202602813362658.