Comparison of Treatment Outcomes Between Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy for Renal Stones Larger Than 2 cm at Nakhon Phanom Hospital

Abstract

Objectives: This study aimed to compare surgical outcomes between PCNL and RIRS in patients with renal stones which larger than 2 cm at Nakhon Phanom Hospital.

Methods: This study was retrospective cohort study. 111 patients with renal stones which larger than 2 cm who underwent surgery between January 2022 and October 2025. Patients were divided into 2 groups, PCNL group (n = 52) and RIRS group (n = 59). Baseline characteristics, renal stone characteristics, surgical outcomes, and postoperative complications were collected from electronic medical records. Statistical analyses, including logistic regression analysis, were performed to identify factors associated with stone-free status and complications.

Results: The PCNL group had larger stones than the RIRS group, significantly (3.63 and 2.5 cm, p < 0.001). Although the overall stone-free rate was not significantly different between the two groups (48.08% vs. 44.07%, p = 0.706), multivariable analysis demonstrated that PCNL was independently associated with a higher likelihood of achieving stone-free status compared with RIRS (adjusted OR 3.89, 95% CI 1.39–10.86, p = 0.009). Larger stone size and lower pole stones were associated with lower stone-free rates. In addition, the PCNL group had significantly longer operative time, higher blood loss, and higher overall complication rates than the RIRS group (69.23% vs. 13.56%, p < 0.001). PCNL and diabetes mellitus were the independent predictors of overall complications.

Conclusion: RIRS is safer and less invasive alternative surgery with lower blood loss and fewer complications than PCNL. But PCNL was associated with a higher likelihood of stone-free outcomes after adjustment for confounding factors. The operation of choice should be considered depend on the renal stone characteristics and patient-related factors.