Comparison of retrograde ıntrarenal surgery performed with thulium fiber laser lithotripsy and percutaneous nephrolithotomy in the treatment of 20-30 mm kidney stones in adults: a randomized prospective study.

This study aimed to contribute to the literature by investigating whether Retrograde Intrarenal Surgery (RIRC) performed with Thulium Fiber Laser Lithotripsy (TFLLT) can be an alternative to Percutaneous Nephrolithotomy (PNL), which is still considered the gold standard, for the treatment of kidney stones measuring 20-30 mm, a more invasive procedure. Between April 2022 and June 2024, patients with a single kidney stone (Guy stone score 1) located in the renal pelvis, lower pole, or middle pole, measuring between 20-30 mm, were randomized at the Urology Clinic of Atatürk University Research Hospital. A total of 86 patients were included in the study. 44 patients (51.1%) underwent RIRS with TFLLT, and 42 patients (48.8%) underwent PNL. The mean stone size was 24.7 ± 1.8 mm in the RIRS group and 24.8 ± 1.7 mm in the PNL group. There was no statistically significant difference in demographics and stone characteristics between the two groups (p0.05). Stone-free rates were statistically similar between the two groups (p=0.714). The mean operative time was longer in the RIRS group, while the mean hemoglobin decrease and hospital stay were longer in the PNL group (p0.001). No statistically significant difference was found in postoperative complications between the groups (p=0.806). In the treatment of kidney stones measuring 20-30 mm, RIRC with TFLLT provides advantages over PNL, including lower blood loss, shorter hospitalization, lower fluoroscopy time, less postoperative pain, and lower analgesic consumption. With similar complication and stone-free rates, thulium fiber laser lithotripsy (TFLLT) performed via retrograde intrarenal surgery (RIRS) may have the potential to be a safe and effective alternative to percutaneous nephrolithotomy (PNL). Further studies with larger patient series will contribute to the literature.