A prospective comparative study between retrograde intrarenal surgery vs supine mini percutaneous nephrolithotomy for single upper ureteric stones >10 mm.

Introduction: To compare retrograde intrarenal surgery (RIRS) and supine mini percutaneous nephrolithotomy (smPCNL) in the management of upper ureteric stones larger than 10 mm.

Material and methods: Patients with upper ureteric stones (above L4 vertebra transverse process) larger than 10 mm at Ford Hospital and Research Centre between January 2023 and June 2024 were included in the study and were operated with either RIRS (group A) or smPCNL (group B) based on the informed consent and patients' decision. Patient demographics, stone parameters, intraoperative variables, postoperative outcomes, stone-free rates (SFR) and complications were recorded, and the two groups were compared.

Results: Over 18 months, 140 patients (70 in each group) were available for comparison. Both the groups were comparable in terms of patient's demographics and the stone parameters. For RIRS and smPCNL, the mean stone size was 13.87 ±3.69 and 14.21 ±3.47 mm (p = 0.329), mean operative duration was 42.52 ±28.37 and 30.69 ±18.55 minutes (p = 0.0001), mean drop in haemoglobin at 24 hours was 0.44 ±0.96 and 0.69 ±0.92 g/dl (p = 0.364) and postoperative hospital stay was 0.92 ±0.68 and 1.13 ±0.76 days, respectively.The SFR (at 3 months post-surgery) were 94.2% for RIRS and 98.57% for smPCNL (p = 0.084) and complications rate (Clavien-Dindo ≥II) was 2.88% for both groups. Primary access was not possible in 30% of patients in RIRS leading to staged intervention.

Conclusions: RIRS and smPCNL are safe and effective surgical alternatives for managing upper ureteric stones larger than 10 mm. smPCNL offers a single stage solution and equivalent results with RIRS for the large upper ureteric stones.