Retrograde intrarenal surgery in the management of solitary large renal stones, 2-3 cm: a single center experience

Ahmed Eissa, Maged Ragab, Giampoalo Bianchi, Ayman Hassan


Background: Nephrolithiasis represents a major health burden worldwide. Several treatment options are available for renal stones such as open stone surgery, percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and extracorporeal shockwave lithotripsy. PCNL is considered the gold standard treatment for large renal stones (>2 cm); however, it is associated with higher blood loss, complication rates, and longer hospitalization. In this setting, we aimed to assess the value of RIRS in the management of single large renal stones between 2-3 cm. 

Methods: The database of our center was reviewed to include all the patients who underwent RIRS for single large renal stone (2-3 cm) between February 2018 and April 2019. All the patients were evaluated by preoperative computed tomography to evaluate the stone size, site, and density. Furthermore, the following variables were also collected; pre- and post-operative hemoglobin and creatinine, the operative time, stone free rate (SFR), and duration of hospital stay. All the statistical analysis was performed using SPSS version 20.

Results: Overall, the data of 31 patients were retrieved for the current study. The mean age of the patients was 56.9±12.9 years, and the mean stone size was 22.6±7 mm. The mean operative time was 96.4±37.3 minutes and the SFR was 74.2% after single session of RIRS. No major postoperative complications were reported in the current series.

Conclusions: RIRS is a safe and efficient alternative to PCNL in the management of single renal stones between 2-3 cm; however, further prospective studies are required to confirm these findings.


Retrograde intrarenal surgery, Renal stones, Minimally invasive, RIRS

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Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-20.

Bonzo JR, Tasian GE. The Emergence of Kidney Stone Disease During Childhood-Impact on Adults. Curr Urol Rep. 2017;18(6):44.

Yasui T, Okada A, Hamamoto S, Ando R, Taguchi K, Tozawa K et al. Pathophysiology-based treatment of urolithiasis. Int J Urol. 2017;24(1):32-8.

Moreno-Palacios J, Avilés-Ibarra OJ, García-Peña E, Torres-Anguiano JR, Serrano-Brambilia EA, López-Sámano VA et al. Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy. Turk J Urol. 2018;44(1):36-41.

Jones P, Elmussareh M, Aboumarzouk OM, Mucksavage P, Somani BK. Role of Minimally Invasive (Micro and Ultra-mini) PCNL for Adult Urinary Stone Disease in the Modern Era: Evidence from a Systematic Review. Curr Urol Rep. 2018;19(4).

ElSheemy MS, Elmarakbi AA, Hytham M, Ibrahim H, Khadgi S, Al-Kandari AM. Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study. Urolithiasis. 2019;47(2):207-14.

De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: A systematic review and meta-analysis. Eur Urol. 2015;67(1):125-37.

Chung KJ, Kim JH, Min GE, Park HK, Li S, Del Giudice F. Changing Trends in the Treatment of Nephrolithiasis in the Real World. J Endourol. 2019;33(3):248-53.

Erkoc M, Bozkurt M. Comparison of Mini-Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Pelvic Stones of 2-3 cm. J Laparoendosc Adv Surg Tech. 2020;2020:0860.

Dretler SP, Watson G, Parrish JA, Murray S. Pulsed dye laser fragmentation of ureteral calculi: Initial clinical experience. J Urol. 1987;137(3):386-9.

Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X et al. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta‑analysis. Exp Ther Med. 20195;18(2).

Barone B, Crocetto F, Vitale R, Di Domenico D, Caputo V, Romano F et al. Retrograde intra renal surgery versus percutaneous nephrolithotomy for renal stones >2 cm. A systematic review and meta-analysis. Minerva Urol e Nefrol. 2020;72(4):441-50.

Chen HQ, Chen ZY, Zeng F, Li Y, Yang ZQ, He C et al. Comparative study of the treatment of 20–30 mm renal stones with miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy in obese patients. World J Urol. 2018;36(8):1309-14.

Goldberg H, Golomb D, Shtabholtz Y, Tapiero S, Creiderman G, Shariv A et al. The “old” 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World J Urol. 2017;35(12):1947-54.

Abd El Hamed AM, Elmoghazy H, Aldahshoury M, Riad A, Mostafa M, Farag F et al. Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?. Turk J Urol. 2017;43(2):158-61.

Breda A, Angerri O. Retrograde intrarenal surgery for kidney stones larger than 2.5cm. Curr Opin Urol. 2014;24(2):179-83.

Zhu Z, Cui Y, Zeng F, Li Y, Chen Z, Hequn C. Comparison of suctioning and traditional ureteral access sheath during flexible ureteroscopy in the treatment of renal stones. World J Urol. 2019;37(5):921-9.

Tokas T, Skolarikos A, Herrmann TRW, Nagele U. Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol. 2019;37(1):133-42.

Tepeler A, Akman T, Silay MS, Akcay M, Ersoz C, Kalkan S et al. Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy. Urolithiasis. 2014;42(3):275-9.