Nowadays the technology helps the urologists by providing modern, highly advanced instruments to make treatment modalities safer and more efficient, AUA and EAU guidelines recommended PCNL as alternative therapy for large stones. By using smaller sheaths (< 20 Fr) the mini PCNL becomes popular and provide more safety to the patients with renal stones, also RIRS could be alternative treatment as it showed less complications [
15],
16,
17, Yan et al. 2012 showed that stone free rate in preschool children with single renal stone < 20 mm treated by mini-PCNL is better than those with more than 2 stones or larger than 20 mm [
18]. After that Pei lu et al., 2017 showed that using PCNL for treatment of renal stones in children in comparison to RIRS has a higher stone free rate and no difference in operative time and complication rate [
19]. Meanwhile Hyams et al. 2010 recorded 83% residual stones < 4 mm in 120 patients treated with RIRS for renal stones 20–30 mm and the complication rate was 6.7% [
20]. In 2014 Giusti et al., the stone free rate was 87.7% in total number of 162 patients with average stone diameter 20.7 ± 6 mm treated by RIRS which considered safe and effective [
21]. Nowadays, RIRS is considered an excellent alterative modality of treatment of kidney stones not exceeding 20 mm and recorded higher stone free rate [
22]. By comparing the complication rate of mini PCNL and RIRS we will have a lower complication rate in RIRS than in mini-PCNL, however, the morbidity results like hemorrhage, pain and fever of both mini-PCNL and standard PCNL are similar and not common to be faced [
23. This study was carried on by applying both minimally invasive techniques (mini-PCNL and RIRS) on renal stones 20–30 mm and compared both results to conclude which is better in efficacy and safety (Table
5).
Table 5
Procedure complications are listed according to the modified Clavien score
Grade 1: fever | 1 | 2.9 |
Grade 2: blood transfusion | 1 | 2.9 |
Grade 3a: urinoma (treated conservatively) | 1 | 2.9 |
Grade 3b: need an intervention under GA | None | 0 |
Grade 4a: organ injury or dysfunction | None | 0 |
Grade 4b: multiple organ injury or dysfunction | None | 0 |
Grade 5: death | None | 0 |
In many studies the Stone characters were recorded as [
24] showed Stone diameter 20.6 mm in group A (mini PCNL) & 20.3 mm in group B (RIRS), similar results of [
25] reported demographic data in the form of Mean stone size 20.5 ± 10.2 mm in group A (mini PCNL) & 20.3 ± 10.2 mm in group B & stone side (Right/Left) 50/27 in group A (mini PCNL) & 21/11 in group B, moreover [
26] studied. The stone characteristics which showed mean stone size 1.47 cm (3; 8–2.0) in group A (mini PCNL) & 1.41 cm (0.3; 0.8–2.0) in group B RIRS, percentage of RT sided stone was 34 (56.7%) in group A (mini PCNL)& 38 (63.3%) in group B in comparison to our study data showed mean stone size 24.3 ± 2.2 mm in group A & 20.5 ± 2,1 mm in group B, stone side (Right/Left) 18/17 in group A (mini PCNL)&12/23 in group B, so the stone size in the present study is larger than those in the previous mentioned studies. The operative time conducted in many studies as [
24] showed operative time 63 (min) in group A (mini PCNL)& 81 min in group B &Also [
25] study reported Mean operative time 62.5 ± 20.67 in group A (mini PCNL)& 67.5 ± 22.34 in group B & [
26] study data as regard operating time was 71.66 (10.36) in group A(mini PCNL)& 109.66 (20.75) in group B &According to [
27] twelve studies reported Operative times, and six studies have shown that mini-PCNL spends shorter operating time compared to four studies favored RIRS, in comparison to our study which was 59.7 + _19.44 in group A (mini PCNL)& 80.3 + _14.7 in group B so we are less in operative time than all previous studies in group A (mini PCNL) but in group B we are less than [
24] & [
26] study but more than [
25]. About hospital stay [
24] repoted 2.3 day in group A(mini PCNL)& 1.1 day in group B (RIRS)& [
25] showed Hospital stay 2.4 ± 0.49 day in group A & 1.09 ± 0.29 day in group B (RIRS) in comparison to our study which was 1.41 ± 0.46 day in group A (mini PCNL)& 1.29 ± 0.44 day in group B (RIRS), so we are less than 2 previous studies in hospital stay in group A (mini PCNL)but slightly higher in group B (RIRS). For hemoglobin level and blood loss [
24] reported
a decrease in hemoglobin level (mg/dL) 1.4 in group A (mini PCNL)& 0.3 in group B (RIRS)& B in comparison to our study which shows minimal drop of Hb which was was 0.7 in group A (mini PCNL)& 0 in group B (RIRS) and reporting a transfusion rate 1(2.9%) in group A (mini PCNL)& 0 in group B (RIRS) which is lesser than [
25] with Transfusion rate 5.1% (4/77) in group A (mini PCNL)& 0 in group B (RIRS). The most important factor which affects the success of the maneuver is the stone free rate which reported in [
24] study 95.5%in group A (mini PCNL)& 80.6% in group B (RIRS)& [
25] showed stone free rate 96.1% in group A (mini PCNL)& 90.6% in group B (RIRS) and [
26] study As regard SFR results was 92.72% in group A (mini PCNL)& 84.31 in group B (RIRS) and in comparison to ours which was 88.6 in group A (mini PCNL)& 82.9 in group B (RIRS), and that denotes that we are less SFR in group A(mini PCNL) than previous studies but high than [
24] study in group B (RIRS). We reported minor intraoperative complications in group A (mini PCNL) in the form of one case of m PCNL (2.9%) with significant bleeding for which one unit blood were transfused, one patient of m PCNL (2.9%) with renal pelvic perforation and extravasation which was a small perforation and both cases were resolved with Double J stent, conservative measures and nephrostomy tubes were inserted and post-operative complications in one case of group A (mini PCNL)(2.9%) developed postoperative fever. In our study complications assessed using the modified Clavien grading System which showed; Grade 1: one case in group A (mini PCNL)& 0 in group B (RIRS), grade 2: one case in group A (mini PCNL)& 0 in group B (RIRS), grade 3A: one case in group A (mini PCNL)& 0 in group B (RIRS) also grade 3B: 0 in group A (mini PCNL)& 0 in group B (RIRS) also 0 in grade 4 & 5 in both groups and these records is less in grades 1 & 2 &3 and the same in other grades in comparison to [
24] which reported
; Grade 1: 5 cases in group A (mini PCNL)& 3 cases in group B (RIRS), grade 2: 3 cases in group A (mini PCNL)& 4 cases in group B (RIRS), grade 3A: one case in group A(mini PCNL)& 0 in group B (RIRS) also grade 3B: one case in group A & 0 in group B (RIRS) also 0 in grade 4 & 5 in both groups.