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. 2023 Nov 13;11(11):CD013445.
doi: 10.1002/14651858.CD013445.pub2.

Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults

Leah Soderberg #  1 , Onuralp Ergun #  2   3 , Maylynn Ding  4 , Robin Parker  5 , Michael S Borofsky  3 , Vernon Pais  6 , Philipp Dahm  2   3
Affiliations

Percutaneous nephrolithotomy versus retrograde intrarenal surgery for treatment of renal stones in adults

Leah Soderberg et al. Cochrane Database Syst Rev. .

Abstract

Background: Kidney stones (also called renal stones) can be a source of pain, obstruction, and infection. Depending on size, location, composition, and other patient factors, the treatment of kidney stones can involve observation, shock wave lithotripsy, retrograde intrarenal surgery (RIRS; i.e. ureteroscopic approaches), percutaneous nephrolithotomy (PCNL), or a combination of these approaches.

Objectives: To assess the effects of percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults.

Search methods: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, Scopus, and two trials registries up to 23 March 2023. We applied no restrictions on publication language or status.

Selection criteria: We included randomized controlled trials that evaluated PCNL (grouped by access size in French gauge [Fr] into three groups: ≥ 24 Fr [standard PCNL], 15-23 Fr [mini-PCNL and minimally invasive PCNL], and < 15 Fr [ultra-mini-, mini-micro-, super-mini-, and micro-PCNL]) versus RIRS.

Data collection and analysis: Two review authors independently selected studies and extracted data from the included studies. Our primary outcomes were stone-free rate, major complications, and need for secondary interventions. Our main secondary outcomes were unplanned medical visits to emergency/urgent care or outpatient clinic, length of hospital stay, ureteral stricture or injury, and quality of life. We performed statistical analyses using a random-effects model. We rated the certainty of evidence using GRADE criteria. We adopted a minimally contextualized approach with predefined thresholds for minimal clinically important differences (MCIDs).

Main results: We included 42 trials assessing the effects of PCNL versus RIRS in 4571 randomized participants. Twenty-two studies were published as full-text articles, and 20 were published as abstract proceedings. The average size of stones ranged from 10.1 mm to 39.1 mm. Most studies did not report sources of funding or conflicts of interest. The main results for the most important outcomes are summarized below. Stone-free rate PCNL compared with RIRS may improve stone-free rates (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08 to 1.18; I2 = 71%; 39 studies, 4088 participants; low-certainty evidence). Based on 770 participants per 1000 being stone-free with RIRS, this corresponds to 100 more (62 more to 139 more) stone-free participants per 1000 with PCNL (an absolute difference of 10%, where the predefined MCID was 5%). Major complications PCNL compared with RIRS probably has little or no effect on major complications (RR 0.86, 95% CI 0.59 to 1.25; I2 = 15%; 34 studies, 3649 participants; moderate-certainty evidence). Based on 31 complications in the RIRS group, this corresponds to six fewer (13 fewer to six more) major complications per 1000 with PCNL (an absolute difference of 0.6%, where the predefined MCID was 2%). Need for secondary interventions PCNL compared with RIRS may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17 to 0.55; I2 = 61%; 21 studies, 2005 participants; low-certainty evidence). Based on 222 secondary interventions in the RIRS group, this corresponds to 153 fewer (185 fewer to 100 fewer) secondary interventions per 1000 with PCNL (an absolute difference of 15.3%, where the predefined MCID was 5%). Unplanned medical visits No studies reported unplanned medical visits. Length of hospital stay PCNL compared with RIRS may extend length of hospital stay (mean difference 1.04 days more, 95% CI 0.27 more to 1.81 more; I2 = 100%; 26 studies, 2804 participants; low-certainty evidence). This effect size is greater than the predefined MCID of one day. Ureteral stricture or injury PCNL compared with RIRS may have little or no effect on the occurrence of ureteral strictures (RR 0.93, 95% CI 0.39 to 2.21; I2 = 0%; 13 studies, 1574 participants; low-certainty evidence). Based on 14 ureteral strictures in the RIRS group, this corresponds to one fewer (nine fewer to 17 more) ureteral strictures per 1000 with PCNL (an absolute difference of 0.1%, where the predefined MCID was 2%). Quality of life No studies reported quality of life.

Authors' conclusions: Based on a large body of evidence from 42 trials, we found that PCNL compared with RIRS may improve stone-free rates and may reduce the need for secondary interventions, but probably has little or no effect on major complications. PCNL compared with RIRS may have little or no effect on ureteral stricture rates and may increase length of hospital stay. We found no evidence on unplanned medical visits or participant quality of life. Because of the considerable shortcomings of the included trials, the evidence for most outcomes was of low certainty. Access size for PCNL was less than 24 Fr in most studies that provided this information. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.

Trial registration: ClinicalTrials.gov NCT02430168 NCT03112499 NCT03307096.

PubMed Disclaimer

Conflict of interest statement

LS: none. OE: is a Fellow for Cochrane Urology; however, he was not involved in the editorial process of this review. MD: none. RP: none. MB: Boston Scientific (consultant for endourology and stone management), Auris Health (consultant for robotic surgery and endourology). VP: none. PD: is the Co‐ordinating Editor of Cochrane Urology; however, he was not involved in the editorial process of this review.

Figures

1
1
PRISMA diagram illustrating the study selection process.
2
2
Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.1 Stone‐free rate.
5
5
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.2 Major complications.
6
6
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.3 Secondary interventions.
7
7
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.4 Length of hospital stay
8
8
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.5 Minor complications.
9
9
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.7 Procedure time.
10
10
Funnel plot of comparison: 1 Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), outcome: 1.10 Ureteral stricture or injury.
1.1
1.1. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 1: Stone‐free rate
1.2
1.2. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 2: Major complications
1.3
1.3. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 3: Secondary interventions
1.4
1.4. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 4: Length of hospital stay
1.5
1.5. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 5: Minor complications
1.6
1.6. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 6: Blood transfusions
1.7
1.7. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 7: Procedure time
1.8
1.8. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 8: Postprocedure drainage tube or stent
1.9
1.9. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 9: Duration of postprocedure drainage tube or stent
1.10
1.10. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 10: Ureteral stricture or injury
1.11
1.11. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 11: Pain on postoperative day 0
1.12
1.12. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 12: Pain on postoperative day 1
1.13
1.13. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 13: Pain on postoperative days 2 to 7
1.14
1.14. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 14: Narcotic analgesic use
1.15
1.15. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 15: Primary treatment failure
1.16
1.16. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 16: Subgroup analysis by access size: stone‐free rate
1.17
1.17. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 17: Subgroup analysis by stone burden: stone‐free rate
1.18
1.18. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 18: Subgroup analysis by stone location: stone‐free rate
1.19
1.19. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 19: Subgroup analysis by stone size: stone‐free rate
1.20
1.20. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 20: Subgroup analysis by access size: major complications
1.21
1.21. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 21: Subgroup analysis by stone burden: major complications
1.22
1.22. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 22: Subgroup analysis by stone location: major complications
1.23
1.23. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 23: Subgroup analysis by stone size: major complications
1.24
1.24. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 24: Subgroup analysis by access size: secondary interventions
1.25
1.25. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 25: Subgroup analysis by stone burden: secondary interventions
1.26
1.26. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 26: Subgroup analysis by stone location: secondary intervention
1.27
1.27. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 27: Subgroup analysis by stone size: secondary intervention
1.28
1.28. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 28: Sensitivity analysis for stone‐free rate by definition of stone freedom (≤ 4 mm by any imaging modality)
1.29
1.29. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 29: Sensitivity analysis for stone‐free rate by definition of stone freedom (≤ 2 mm by any imaging modality)
1.30
1.30. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 30: Sensitivity analysis for stone‐free rate by definition of stone freedom (totally stone‐free by CT scan)
1.31
1.31. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 31: Sensitivity analysis for major complications by definition of stone freedom (≤ 4 mm by any imaging modality)
1.32
1.32. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 32: Sensitivity analysis for major complications by definition of stone freedom (≤ 2 mm by any imaging modality)
1.33
1.33. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 33: Sensitivity analysis for major complications by definition of stone freedom (totally stone‐free by CT scan)
1.34
1.34. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 34: Sensitivity analysis for secondary interventions by definition of stone freedom (≤ 4 mm by any imaging modality)
1.35
1.35. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 35: Sensitivity analysis for secondary interventions by definition of stone freedom (≤ 2 mm by any imaging modality)
1.36
1.36. Analysis
Comparison 1: Percutaneous nephrolithotomy (PCNL) versus retrograde intrarenal surgery (RIRS), Outcome 36: Sensitivity analysis for secondary interventions by definition of stone freedom (totally stone‐free by CT scan)
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Update of

  • doi: 10.1002/14651858.CD013445

References

References to studies included in this review

Abo Ghareeb 2021 {published data only}
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Albayrak 2019 {published data only}
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Bailie 2018 {published data only}
    1. Bailie J, Shahbaz S, Berman I, Hong M, McCahy P. The best treatment for 10-20mm renal stones: a pilot randomised controlled trial of extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy. Journal of Endourology 2018;32(Suppl 2):128. [DOI: ]
Berti 2021 {published data only}
    1. Berti L, Maltagliati M, Buizza C, Besana U, Calori A, Antonelli D, et al. A comparison among RIRS and MiniPerc for renal stones between 1-2 cm: a randomized controlled trial. European Urology 2021;79:389. [DOI: ]
Berti 2022 {published data only}
    1. Berti L, Maltagliati M, Besana U, Buizza C, Pacchetti A, Micali S, et al. A comparison among RIRS and miniPERC for renal stones between 1 and 2 cm using fiber dust: a RCT. European Urology 2022;81:1483. [DOI: ] - PubMed
Bozzini 2017 {published data only}
    1. Bozzini G, Verze P, Arcaniolo D, Dal Piaz O, Buffi NM, Guazzoni G, et al. A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: a multicenter experience: a better understanding on the treatment options for lower pole stones. World Journal of Urology 2017;35(12):1967‐75. [DOI: 10.1007/s00345-017-2084-7] - DOI - PubMed
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Bryniarski 2012 {published data only}
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Cakici 2020 {published data only}
    1. Cakici MC, Karakoyunlu N, Sari S, Ozok HU, Selmi V, Kartal, IG, et al. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy used in the treatment of 2-4 cm kidney stones in terms of pain and need for additional analgesics: a prospective randomized study. Journal of Laparoendoscopic & Advanced Surgical Techniques 2020;30(12):1301-7. [DOI: 10.1089/lap.2020.0179] - DOI - PubMed
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Datta 2022 {published data only}
    1. Datta SN, Chalokia RS, Wing KW, Patel K, Solanki R, Desai J. Ultramini‐percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of 10–30 mm calculi: a randomized controlled trial. Urolithiasis 2022;50:361-7. [DOI: 10.1007/s00240-022-01304-7] - DOI - PubMed
Demirbas 2016 {published data only}
    1. Demirbas A, Resorlu B, Sunay MM, Karakan T, Karagoz MA, Doluoglu OG. Which should be preferred for moderate-size kidney stones? Ultramini percutaneous nephrolithotomy or retrograde intrarenal surgery? Journal of Endourology 2016;30(12):1285-9. [DOI: 10.1089/end.2016.0370] - DOI - PubMed
Fayad 2017 {published data only}
    1. Fayad AS, Elsheikh MG, Ghoneima W. Tubeless mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for lower calyceal stones of ⩽2 cm: a prospective randomised controlled study. Arab Journal of Urology 2017;15(1):36-41. [DOI: 10.1016/j.aju.2016.10.002] - DOI - PMC - PubMed
Fayad 2021 {published data only}
    1. Fayad MK, Fahmy O, Abulazayem KM, Salama NM. Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal pelvic stone more than 2 centimeters: a prospective randomized controlled trial. Urolithiasis 2022;50:113-7. [DOI: 10.1007/s00240-021-01289-9] - DOI - PubMed
Giusti 2011 {published data only}
    1. Giusti G, Bonvissuto G, Zandegiacomo S, Taverna G, Maugeri O, Benetti A, et al. Comparison between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment of single pelvic renal stones between 2 and 4 cm. European Urology Supplements 2011;10(2):94.
Hong 2016 {published data only}
    1. Hong M, Paul E, Berman I, Shahbaz S, McCahy P. The optimal treatment for 1-2 cm renal stones: randomised trial of percutaneous nephrolithotomy versus ureterorenoscopy versus shockwave lithotripsy. BJU international 2016;117(S3):57‐8. [DOI: 10.1111/bju.13452] - DOI
Jiang 2018 {published data only}
    1. Jiang K, Chen H, Yu X, Chen Z, Ye Z, Yuan H. The "all-seeing needle" micro-PCNL versus flexible ureterorenoscopy for lower calyceal stones of ≤ 2 cm. Urolithiasis 2018;47:201-6. [DOI: 10.1007/s00240-018-1049-7] - DOI - PubMed
Jin 2019 {published data only}
    1. Jin L, Yang B, Zhou Z, Li N. Ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of medium-sized lower-pole renal calculi. Journal of Endourology 2019;33:914-9. [DOI: 10.1089/end.2019.0504] - DOI - PubMed
Kandemir 2017 {published data only}
    1. Kandemir A, Guven S, Balasar M, Sonmez MG, Taskapu H, Gurbuz R. A prospective randomized comparison of micropercutaneous nephrolithotomy (Microperc) and retrograde intrarenal surgery (RIRS) for the management of lower pole kidney stones. World Journal of Urology 2017;35(11):1771-6. [DOI: 10.1007/s00345-017-2058-9] - DOI - PubMed
Karakoyunlu 2015 {published data only}
    1. Karakoyunlu N, Goktug G, Sener NC, Zengin K, Nalbant I, Ozturk U, et al. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study. Urolithiasis 2015;43(3):283-7. [DOI: 10.1007/s00240-015-0768-2] - DOI - PubMed
    1. NCT02430168. Comparison of RIRS Versus PCNL Methods, According to Postoperative Pain and Analgesic Demand in 2 to 4 cm Renal Stones. clinicaltrials.gov/study/NCT02430168 (first received 30 April 2015).
Klein 2019 {published data only}
    1. Klein I, Dutta R, Colaco M, Patel M, Gutierrez-Aceves J. Procedural costs and outcomes following mini-percutaneous nephrolithotomy or flexible ureteroscopic lithotripsy for nephrolithiasis: data from a prospective, randomized clinical trial. Journal of Urology 2019;201(Suppl 4):e1093-4. [DOI: 10.1097/01.JU.0000557284.35202.8f] - DOI - PubMed
Kumar 2015 {published data only}
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Lee 2015 {published data only}
    1. Lee JW, Park J, Lee SB, Son H, Cho SY, Jeong H. Mini-percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger than 10 mm: a prospective randomized controlled trial. Urology 2015;86(5):873-7. [DOI: 10.1016/j.urology.2015.08.011] - DOI - PubMed
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Li 2016a {published data only}
    1. Li JW, Wang F, Cai FZ, Gao HZ. Staged retrograde flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for renal stones of 2-4 cm in diameter: a randomized controlled trial. Nan fang yi ke da xue xue bao [Journal of Southern Medical University] 2016;36(12):1672‐76. [PMID: ] - PubMed
Li 2016b {published data only}
    1. Li ZG, Zhao Y, Fan T, Hao L, Han CH, Zang GH. Clinical effects of FURL and PCNL with holmium laser for the treatment of kidney stones. Experimental and Therapeutic Medicine 2016;12(6):3653‐7. [DOI: 10.3892/etm.2016.3835] - DOI - PMC - PubMed
Liu 2021 {published data only}
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McCahy 2020 {published data only}
    1. Bailie J, Shahbaz S, Berman I, Hong M, McCahy, P. The best treatment for 10-20mm renal stones: a pilot randomised controlled trial of extracorporeal shock wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy. Journal of Endourology 2018;32(S2):ePub. [DOI: 10.1089/end.2018.29043.abstracts] - DOI
    1. McCahy PJ, Hong M, Paul E, Berman I, Shahbaz S. Shock-wave lithotripsy, ureterorenoscopy and percutaneous nephrolithotomy for 1–2 cm renal stones: a randomised pilot study. Journal of Clinical Urology 2020;13(6):413-8. [DOI: 10.1177/2051415820935663] - DOI
Mhaske 2018 {published data only}
    1. Mhaske S, Singh M, Mulay A, Kankalia S, Satav V, Sabale V. Miniaturized percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of renal stones with a diameter <15 mm: a 3-year open-label prospective study. Urology Annals 2018;10(2):165‐9. [DOI: 10.4103/UA.UA_156_17] - DOI - PMC - PubMed
Mishra 2012 {published data only}
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    1. Vyas J, Doshi A, Ganpule A, Mishra S, Raghuram Sabnis R, Desai M, et al. Prospective randomized study to compare safety and efficacy of micro percutaneous nephrolithotomy (MICRO PERC) in comparison to retrograde intra renal surgery (RIRS). Urology 2012;80(3):S174.
Mrabti 2020 {published data only}
    1. Mrabti M, Jendouzi O, Khdach Y, Boukhlifi Y, Tetou M, João Peti Â, et al. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotomy in the management of 20 - 30 mm renal stones. European Urology Open Science 2020;19(Suppl 2):e1868. [DOI: 10.1016/S2666-1683(20)33860-X] - DOI
Oo 2020 {published data only}
    1. Oo SM. Outcomes of minipercutaneous nephrolithotomy versus retrograde intrarenal surgery in lower pole renal stone. International Journal of Urology 2020;27(S1):40. [DOI: ]
Pattnaik 2019 {published data only}
    1. Pattnaik PK, Pattnaik SK, Pattnaik, MP. Comparison of mini PCNL v/s retrograde intrarenal surgery (RIRS) v/s extracorporeal shockwave lithotripsy (ESWL) for the treatment of renal stones up to 2.5 centimeters. Journal of Endourology 2019;33(S1):A260. [DOI: ]
Ragy 2020 {published data only}
    1. Ragy SI, Elshorbagy AA, Alzqzouq MA. Retrograde intrarenal surgery (RIRS) vs percutaneous nephrolithotomy (PCNL) in treatment of lower pole renal stone. QJM: An International Journal of Medicine 2020;113(Suppl 1):257. [DOI: 10.1093/qjmed/hcaa070.006] - DOI
Rajwardhan 2016 {published data only}
    1. Rajwardhan S, Singh SK, Pawar DS. Comparison of surgical outcomes in the treatment of renal stone of size <15 mm between mini PCNL and RIRS: a single centre, randomized, prospective study. Indian Journal of Urology 2016;32:S38-S165. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064671/pdf/IJU-32-38.pdf] [PMID: ]
Sabnis 2013 {published data only}
    1. Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU International 2013;112(3):355-61. [DOI: 10.1111/bju.12164] - DOI - PubMed
Saygin 2020 {published data only}
    1. Gökce G, Saygin H, Korğali E, Efe FM, Dundar G, Gultekin EY, et al. The evaluation of extracorporeal shockwave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and micro percutaneous nephrolithotomy (mPCNL) treatments in kidney stones smaller than two centimeters. Journal of Endourology 2014;28:A267‐8. [DOI: 10.1089/end.2014.3500] - DOI
    1. Saygin H, Gökce G, Korğali E. The evaluations of ESWL, RIRS and m-PCNL treatments in kidney stones smaller than two centimeters. Medical Science and Discovery 2020;7(4):450-4. [DOI: 10.36472/msd.v7i4.366] - DOI
Shah 2010 {published data only}
    1. Shah H, Jain M, Verma R, Bansal M. A prospective randomized trial comparing safety and efficacy of retrograde intrarenal surgery (RIRS) vs. tubeless percutaneous nephrolithotomy (PCNL) in management of medium sized renal calculi (11-20 mm dimension). Journal of Urology 2010;183(4):e493-4. [DOI: 10.1016/j.juro.2010.02.845] - DOI
Soomro 2018 {published data only}
    1. Soomro A, Saulat S, Qadri S. Endourological management of renal calculi of 1 to 2cm size, tubeless mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery, who is the winner? Journal of Endourology 2018;32(Suppl 2):A263-4. [DOI: 10.1089/end.2018.29043.abstracts] - DOI
Terribile 2019 {published data only}
    1. Terribile M, Arcaniolo D, Bottone F, Stizzo M, Amicuzi U, Oliva F, et al. Efficacy and safety of SWL, RIRS and PCNL in lower caliceal stones. European Urololgy Supplement 2019;18(7):32971. [DOI: 10.1016/S1569-9056(19)33129-X] - DOI
Yavuz 2018 {published data only}
    1. Yavuz A, Bayar G, Kilinc M, Yazar VM, Cakmak S. Now is the time for individual surgical treatment of lower pole stone: ethical dilemma or scientific truth. Journal of Endourology 2018;32(S2):A121. [DOI: 10.1089/end.2018.29043.abstracts] - DOI
Zeng 2018b {published data only}
    1. NCT02519634. Super-mini percutaneous nephrolithotomy (SMP) versus retrograde intrarenal surgery (RIRS) for symptomatic lower pole renal calculi of 10-20 mm size: a randomized controlled trial. clinicaltrials.gov/study/NCT02519634 (first received 11 August 2015).
    1. Zeng G, Zhang T, Agrawal M, He X, Zhang W, Xiao K, et al. Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: an international multicentre randomised controlled trial. BJU international 2018;122(6):1034-40. [DOI: 10.1111/bju.14427] - DOI - PubMed
    1. Zeng G, Zhang T, Fan J, Zhang W, Yang S, Xiao K, et al. Super-mini percutaneous nephrolithotomy (SMP) versus retrograde intrarenal surgery for the treatment of 1 to 2 cm lower pole renal calculi: a multinational multicenter randomized controlled trial. Journal of Endourology 2017;31:A39.
    1. Zeng G, Zhang T, Fan J, Zhang W, Yang S, Xiao K, et al. Super-mini percutaneous nephrolithotomy (SMP) versus retrograde intrarenal surgery for the treatment of 1-2 cm lower pole renal calculi: a multicenter randomized controlled trial. Journal of Urology 2018;199(4):e720. - PubMed
Zhang 2018 {published data only}
    1. Zhang H, Hong T Y, Li G, Jiang N, Hu C, Cui X, et al. Comparison of the efficacy of ultra-mini PCNL, flexible ureteroscopy, and shock wave lithotripsy on the treatment of 1-2 cm lower pole renal calculi. Urologia Internationalis 2019;102:153-9. - PubMed

References to studies excluded from this review

Assimos 2019 {published data only}
    1. Assimos D. Re: super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: an international multicentre randomised controlled trial. The Journal of Urology 2019;201(1):24. [DOI: 10.1097/01.ju.0000550146.54734.ff] [PMID: ] - DOI - PubMed
Basiri 2009 {published data only}
    1. Basiri A, Simforoosh N, Ziaee A, Shayaninasab H, Moghaddam SM, Zare S. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial. Journal of Endourology 2008;22(12):2677-80. [DOI: 10.1089/end.2008.0095] [PMID: ] - DOI - PubMed
    1. Monga M. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial (editorial comments). International Brazilian Journal of Urology 2009;35(1):97. [DOI: 10.1590/S1677-55382009000100017] - DOI
Black 2019 {published data only}30985345
    1. Black K, Ghani KR. 1.5 cm stone in the lower calyxflexible ureteroscopy vs. percutaneous nephrolithotomy in favor of ureteroscopy. Current Opinion in Urology 2019;29(5):557-9. [DOI: 10.1097/MOU.0000000000000629] [PMID: ] - DOI - PubMed
Chung 2008 {published data only}
    1. Chung BI, Aron M, Hegarty NJ, Desai MM. Ureteroscopic versus percutaneous treatment for medium-size (1–2-cm) renal calculi. Journal of Endourology 2008;22(2):343-6. [DOI: 10.1089/end.2006.9865] - DOI - PubMed
Coskun 2021 {published data only}
    1. Coskun A, Eryildirim B, Sarica K, Çamur E, Can U, Saglam E. Comparison of mini percutaneous nephrolithotomy (mini PCNL) and retrograde intrarenal surgery (RIRS) for the minimal invasive management of lower caliceal stones. Urology Journal 2021;23(18):485-90. [DOI: ] - PubMed
DRKS00007478 {unpublished data only}
    1. DRKS00007478. Ultra-mini PCNL versus flexible ureterorenoscopy: evaluation of outcome, perioperative complications and analgetic consumption for the treatment of patients with kidney stones. drks.de/search/en/trial/DRKS00007478 (first received 12 November 2014).
Jain 2021 {published data only}
    1. Mayank J, Manohar CS, Nagabhushan M, Keshavamurthy R. A comparative study of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for solitary renal stone of 1–2 cm. Urology Annals 2021;13(3):226-31. [DOI: 10.4103/UA.UA_10_20] - DOI - PMC - PubMed
Liu 2013 {published data only}
    1. Liu Y, Zhou Z, Xia A, Dai H, Guo L, Zheng J. Clinical observation of different minimally invasive surgeries for the treatment of impacted upper ureteral calculi. Pakistan Journal of Medical Science 2013;29(6):1358-62. [DOI: 10.12669/pjms.296.3910] - DOI - PMC - PubMed
NCT03112499 {published data only}
    1. NCT03112499. The effect of three endourological procedures for the management of renal calculi regarding acute kidney injury. clinicaltrials.gov/study/NCT03112499 (first received 13 April 2017).
NCT03307096 {published data only}
    1. NCT03307096. Evaluation of two different treatments for lower pore renal stone: microperc vs FURS. clinicaltrials.gov/study/NCT03307096 (first received 11 October 2017).
NCT03932370 {unpublished data only}
    1. NCT03932370. Flexible ureteroscopy versus mini-percutaneous nephrolithotomy for treatment of renal stones. clinicaltrials.gov/study/NCT03932370 (first received 30 April 2019).
Padron 2016 {unpublished data only}
    1. Padrón L. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotomy in the prone position in the management of kidney stones smaller than 15 mm in diameter. Incomplete reference; unable to obtain 2016;(1):9-15.
Selmi 2017 {published data only}
    1. Selmi V, Nalbant I, Ozturk U, Tuygun C, Goktug HNG, Imamoglu MA. Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy methods in treatment of upper calyceal stones of 10-20 mm. Journal of Laparoendoscopic & Advanced Surgical Techniques 2017;27(12):1293-8. [DOI: 10.1089/lap.2016.0634] - DOI - PubMed
Sharma 2014 {published data only}
    1. Sharma K, Singh B, Sankhwar S, Goel A, Dalela D, Sharma P, et al. Retrograde intrarenal surgery versus tubeless percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 10 to 20mm. Indian Journal of Urology 2014;30(Suppl 1):S90-1.
Ucer 2018 {published data only}
    1. Ucer O, Erbatu O, Albaz A C, Gumus B, Muezzinoglu T. Comparison of stone free rates and quality of life between percutaneous nephrolithotomy (PNL) and retrograde intra-renal surgery (RIRS) in management of 2-4 cm renal stones: a prospective controlled study. European Urology Supplements 2018;17(2):e1402. [DOI: 10.1016/S1569-9056(18)31823-2] - DOI - PMC - PubMed
Wymer 2020 {published data only}
    1. Wymer K, Juvet T, Sharma V, Potretzke A, Agarwal D, Rivera M, et al. Comparative cost-effectiveness of percutaneous nephrolithotomy, ureteroscopy, and extracorporeal shock wave lithotripsy for the management of 1-2 cm renal stones. Journal of Urology 2020;203(Suppl 4):e411. [DOI: 10.1097/JU.0000000000000866.05] - DOI - PubMed

References to ongoing studies

ACTRN12618000787280 {unpublished data only}
    1. ACTRN12618000787280. A randomised controlled trial comparing mini-PCNL with flexible ureteropyeloscopy for urinary tract calculi. anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000787280 (first received 5 September 2018).
ChiCTR1800016983 {unpublished data only}
    1. ChiCTR1800016983. Comparison of miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery for the management of 2-3 cm lower pole kidney stones in obese patients: a randomized control trial. chictr.org.cn/showprojEN.html?proj=28869 (first received 5 July 2018) .
ChiCTR1800019553 {unpublished data only}ChiCTR1800019553
    1. ChiCTR1800019553. A multicenter, randomized, controlled trial for the analysis of minimally invasive surgical strategies for different types of kidney stones. chictr.org.cn/showprojEN.html?proj=32642 (first received 5 November 2020).
ChiCTR2000033476 {published data only}
    1. ChiCTR2000033476. Comparative analysis of retrograde intrarenal surgery and ultra-mini percutaneous nephrolithotomy in management of 1-2 cm kidney stones: a randomized controlled trial. chictr.org.cn/showprojEN.html?proj=52775 (first received 2 June 2020).
ChiCTR2000038817 {published data only}
    1. ChiCTR2000038817. Comparing the clinical efficacy, safety and medical expenses of ultra-mini percutaneous nephrolithotomy and flexible ureteroscopy lithotripsy in management of 1-2 cm kidney stone: a prospective randomized controlled trial. chictr.org.cn/showprojEN.html?proj=61967 (first received 4 October 2020).
ChiCTR‐INR‐17013019 {unpublished data only}ChiCTR‐INR‐17013019
    1. ChiCTR-INR-17013019. Comparison of the effect between SMP and RIRS for treating diameter ≤2cm renal stone: a prospective randomized controlled trial. chictr.org.cn/showprojEN.html?proj=21911 (first received 18 October 2017).
CTRI/2021/08/035645 {published data only}
    1. CTRI/2021/08/035645. Comparison of of PCNL(percutaneous nephrolithotomy) and RIRS(retrograde intrarenal surgery) for renal stone less than 20 mm. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=57345 (first received 13 August 2021.
IRCT20190624043991N5 {unpublished data only}
    1. IRCT20190624043991N5. Comparing mini perc outcome and RIRS in treating remaining post-PCNL stones > 2 cm or Hounsfield > 1000 or SSD (skin stone distance) > 10 cm. www.irct.ir/trial/44495 (first received 3 March 2020).
IRCT20190624043991N9 {unpublished data only}
    1. IRCT20190624043991N9. Comparison of PCNL and RIRS surgery results for the treatment of two to four centimeters kidney stones in patients referred to hospital. www.irct.ir/trial/50878 (first received 13 September 2020).
McClinton 2020 {published and unpublished data}
    1. ISRCTN98970319. PUrE: percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones. isrctn.com/ISRCTN98970319 (first received 11 November 2015).
    1. McClinton S, Starr K, Thomas R, MacLennan G, Lam T, Hernandez R, et al. The clinical and cost effectiveness of surgical interventions for stones in the lower pole of the kidney: the percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones randomised controlled trial (PUrE RCT) protocol. Trials 2020;21(1):479. [DOI: 10.1186/s13063-020-04326-x] - DOI - PMC - PubMed
NCT04856722 {unpublished data only}
    1. NCT04856722. Mini-PNL, RIRS, and ESWL for treatment of medium-sized, high-density, non-lower pole, renal stones. clinicaltrials.gov/study/NCT04856722 (first received 23 April 2021).

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