Efficacy of Retrograde Intrarenal Surgery Combined with Super-Mini Percutaneous Nephrolithotomy versus that of Microchannel Percutaneous Nephrolithotomy in the Treatment of Complex Renal Stones.

BACKGROUND

This study aimed to compare the efficacy of retrograde intrarenal surgery (RIRS) combined with super-mini percutaneous nephrolithotomy (SMP) versus microchannel percutaneous nephrolithotomy (MPCNL) for complex renal stones (CRSs) and identify prognostic factors.

METHODS

A retrospective analysis was conducted on 156 patients with CRS (January 2022-January 2025), divided into the RIRS + SMP group (n = 85) and MPCNL group (n = 71). Perioperative indicators, inflammatory stress, renal function, postoperative pain and complications were compared. A 60-day follow-up categorised prognosis into poor (n = 23) and normal (n = 133) groups, with logistic regression analysing poor prognosis factors.

RESULTS

The RIRS + SMP group had a longer operative time but significantly less intraoperative blood loss, shorter postoperative hospital stay and earlier ambulation (p < 0.05) than the MPCNL group. Stone-free rates were comparable and showed no significant difference (p > 0.05). At 3 days postoperatively, inflammatory markers (procalcitonin (PCT), high-sensitivity Creactive protein (hs-CRP), cortisol (Cor) and malondialdehyde (MDA)) and renal function indicators (blood urea nitrogen (BUN), urinary creatinine (UCr) and cystatin C (Cys-C)) were lower in the RIRS + SMP group (p < 0.05) than in the MPCNL group. Visual Analog Scale (VAS) scores were consistently lower at 6, 12, 24 and 48 h postoperatively (p < 0.05), with a reduced overall complication rate (p < 0.05). Multivariate logistic regression identified surgical approach, diabetes mellitus and indwelling catheterisation time as independent poor prognosis risk factors (p < 0.05).

CONCLUSIONS

For CRS, SMP combined with RIRS provides comparable stone clearance rates with superior recovery and fewer complications than MPCNL, whereas diabetes and catheter duration warrant attention as prognostic factors.