[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-454975-105":3,"doc-detail-454975-en":81,"detail-sidebar-cat-0-en-105":98},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","retrograde-intra-renal-surgery-rirs-versus-percutaneous-nephrolithotomy-pnl-as-a-primary-treatment-for-large-renal-stones-prospective-randomized-controlled-trial","Retrograde intra renal surgery (RIRS) versus percutaneous nephrolithotomy (PNL) as a primary treatment for large renal stones - Prospective randomized controlled trial","","Despite the high efficacy of percutaneous nephrolithotomy (PNL), its morbidity and a difficult learning curve limit its desirability, motivating the use of retrograde intra renal surgery (RIRS) as a minimally invasive alternative. This prospective randomized controlled trial compared RIRS and PNL for renal stones sized 2–3 cm in 122 patients, excluding bleeding disorders, pregnancy, and active UTI. Perioperative outcomes and one-month stone free rate by CTUT were assessed. RIRS showed longer lithotripsy time, lower pain and hospital stay, and comparable stone free rates.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/retrograde-intra-renal-surgery-rirs-versus-percutaneous-nephrolithotomy-pnl-as-a-primary-treatment-for-large-renal-stones-prospective-randomized-controlled-trial/454975/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/retrograde-intra-renal-surgery-rirs-versus-percutaneous-nephrolithotomy-pnl-as-a-primary-treatment-for-large-renal-stones-prospective-randomized-controlled-trial/454975.png","ImageObject",300,407,{"name":42,"@type":43},"Marglet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What patient group and stone size were studied for comparing RIRS vs PNL?","Question",{"text":63,"@type":64},"The trial included 122 patients with single renal stones sized 2–3 cm, randomized to either RIRS or PNL arms. Patients with bleeding disorders, pregnancy, and active UTI were excluded.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were treatment outcomes evaluated in the study?",{"text":68,"@type":64},"Operative time, complications, hospital stay, and pain score were recorded perioperatively. The stone free rate (SFR) was assessed by CTUT one month after treatment.",{"name":70,"@type":61,"acceptedAnswer":71},"What were the main comparative findings between RIRS and PNL?",{"text":72,"@type":64},"Stone free rates were comparable (70.5% for RIRS vs 73.8% for PNL). RIRS had a significantly lower pain score and shorter hospital stay, while PNL showed a greater postoperative hemoglobin drop; lithotripsy time was longer in the RIRS group.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},454975,1791173819,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":4,"category_id":86,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":87,"file_id":88,"file_url":89,"file_type":90,"file_size":91,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":86,"language":92,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":93,"faqs":94,"seo_title":95,"seo_description":12,"update_tm":96,"read_time":97,"preview_page_count":4},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc",7,"ARAB JOURNAL OF UROLOGY 2026, VOL. 24, NO. 1, 21–27  \n[https://doi.org/10.1080/20905998.2025.2515354](https://doi.org/10.1080/20905998.2025.2515354)  \n| ORIGINAL ARTICLE   \u003Cbr>Retrograde intra renal surgery (RIRS) versus percutaneous nephrolithotomy (PNL) as a primary treatment for large renal stones: A prospective randomized controlled trial\u003Cbr>Ayman Kassem, Hesham Torad*, Ahmed Essam, Mahmoud Abdel Hamid, Sameih Zamel and Amr Elkady Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt |  |  |\n| --- | --- | --- |\n| ABSTRACT\u003Cbr>Background: Despite the high efficacy of percutaneous nephrolithotomy (PNL), it has more morbidity and a difficult learning curve. Retrograde intra renal surgery (RIRS) was introduced asa minimally invasive procedure for treatment of renal stones.\u003Cbr>Objective: To compare RIRS versus PNL in the management of renal stones sized 2–3 cm. Patient and methods: In this prospective randomized controlled trial, 122 patients with renal stones 2–3 cm were included and divided into two equal groups. Group A underwent RIRS. Group B underwent PNL. Patients with bleeding disorders, pregnancy, active UTI were excluded. Laboratory investigations, Ultrasound, CTUT were done preoperatively. Perioperative outcome (operative time, complications, hospital stay and pain score) was recorded. SFR (stone free rate) was assessed by CTUT after one month.\u003Cbr>Results: The mean stone size for group A and B were 2.11 ± 0.21 and 2.12 ± 0.23, respectively. The Stone free rate was 70.5% in RIRS and 73.8% in PNL (p = 0.840) . lithotripsy time was significantly longer in the RIRS group (84.75 vs 72.95 minutes) (p = 0.019) . PNL group showed significant post-operative hemoglobin drop but with no need for blood transfusion. Highgrade fever was slightly higher in the RIRS group (8.2% vs 6.5%) (p = 0.557) . Sepsis developed in 4.9% of RIRS group and 1.6% of the PNL group (p = 0.362) . One case of mortality was reported in the PNL group. The hospital stay was significantly longer in the PNL group. The mean pain score was significantly lower in the RIRS.\u003Cbr>Conclusion: RIRS can be used as an alternative to PNL for the management of renal stones sized 2–3 cm, with comparable stone free rates, less hospital stays, less pain score, less hemoglobin drops. but longer lithotripsy time. |  | ARTICLE HISTORY\u003Cbr>Received 22 May 2025 Accepted 31 May 2025\u003Cbr>KEYWORDS\u003Cbr>Flexible ureteroscopy; percutaneous nephrolithotomy; renal stones |\n| Introduction\u003Cbr>Urinary calculi are still a cause of significant morbidity despite the advances in the treatment options; with a prevalence rate varying from 1% to 20% [1] . Treatment is based on many parameters such as stone size, number, location and composition in addition to the anatomy of the pelvi-calyceal system.\u003Cbr>Up till now, PNL is considered the standard treatment option for renal stones more than 2 cm according to the American Urological Association (AUA) guidelines, and the European association of urology (EAU) guidelines.\u003Cbr>Despite the high efficacy of PNL defined as a better stone free rate rather than other alternatives, it has more morbidity [2] with more difficult learning curve and less acceptability from some patients to ‘puncture’their kidneys.\u003Cbr>A systematic review done by Seitz, C et al. and included 12,000 patients showed that the rates of complications of PNL were fever (10.8%), transfusion | (7%), thoracic complications (1.5%), sepsis (0.5), organ injury (0.4%), embolization (0.4%), urinoma (0.2%), and death in 0.05%[2] .\u003Cbr>RIRS was introduced as an alternative for the treatment of renal stones with the advantage of being a less invasive procedure and acceptable stone free rates.\u003Cbr>Major technological progress in RIRS has been achieved in the last few years. A systematic review addressing its efficacy in renal stones >2 cm showed a cumulative SFR of 91% with 1.45 procedures/patient; 4.5% of the complications were >Clavien 3 [3,4] .\u003Cbr>The aim of this study was to compare between R","cbCaimEKiuBjEABB","https://ap.wps.com/l/cbCaimEKiuBjEABB","pdf",394370,"English","# Abstract\n# Introduction\n# Patients and methods\n## Study population","[{\"question\":\"What patient group and stone size were studied for comparing RIRS vs PNL?\",\"answer\":\"The trial included 122 patients with single renal stones sized 2–3 cm, randomized to either RIRS or PNL arms. Patients with bleeding disorders, pregnancy, and active UTI were excluded.\"},{\"question\":\"How were treatment outcomes evaluated in the study?\",\"answer\":\"Operative time, complications, hospital stay, and pain score were recorded perioperatively. The stone free rate (SFR) was assessed by CTUT one month after treatment.\"},{\"question\":\"What were the main comparative findings between RIRS and PNL?\",\"answer\":\"Stone free rates were comparable (70.5% for RIRS vs 73.8% for PNL). RIRS had a significantly lower pain score and shorter hospital stay, while PNL showed a greater postoperative hemoglobin drop; lithotripsy time was longer in the RIRS group.\"}]","Retrograde intra renal surgery (RIRS) versus percutaneous nephrolithotomy (PNL) as a primary treatment for large renal stones - Prospective randomized controlled trial | PDF",1790741824,18,{"code":4,"msg":82,"data":99},[100,104,108,112,117,121,124,129,134,137,141],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},"Exam",70,"exam",{"id":113,"doc_module":4,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":118,"show_sort_weight":119,"slug":120},"Technology",50,"technology",{"id":86,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":122,"slug":123},40,"healthcare",{"id":125,"doc_module":4,"doc_module_name":25,"category_name":126,"show_sort_weight":127,"slug":128},8,"Research & Report",30,"research-report",{"id":130,"doc_module":4,"doc_module_name":25,"category_name":131,"show_sort_weight":132,"slug":133},9,"Religion & Spirituality",20,"religion-spirituality",{"id":132,"doc_module":4,"doc_module_name":25,"category_name":135,"show_sort_weight":132,"slug":136},"World Cup","world-cup",{"id":138,"doc_module":4,"doc_module_name":25,"category_name":139,"show_sort_weight":138,"slug":140},10,"Lifestyle","lifestyle",{"id":142,"doc_module":4,"doc_module_name":25,"category_name":143,"show_sort_weight":113,"slug":144},19,"General","general"]