Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery Outcomes for Kidney Stones Larger than 2 cm from Guy's Stone Scoring System Perspective.

OBJECTIVE To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) due to kidney stones larger than 2 cm, together with Guy's stone scores (GSS). MATERIALS AND METHODS The data of eight hundred eleven patients with stone sizes 2-6 cm were operated utilizing PNL (n=361) and RIRS (n=450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS), and Clavien complications (CC) were recorded. RESULTS Although mean operative times were significantly longer in the RIRS group than PNL group in GSS 1, 2 and 3 (p<0.001), it was similar between two groups in GSS4 (p=0,186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on postoperative 10th day (p<0.001), and it raised up to 95.3% and 81.6% after secondary interventions (p<0.001). Significantly higher SFRs observed in the PNL group in GSS 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS 4 categories (p=0,06). LOHS was longer in the PNL group (p<0.001). While LOHS was significantly longer only in GSS 3 (p=0,043) and GSS 4 (p<0.001) in the PNL group, it was similar in GSS 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (p<0.001), but the difference did not differ between GSS 3 and 4. CONCLUSION Stone-free success of PNL in a single session and short operation time seem to be significant especially in GSS 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS 4 because of its lower complication rates and shorter LOHS.