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Background <p>In this prospective controlled cohort study, we aimed to compare the safety and efficacy of Retrograde intrarenal surgery (RIRS) combined with high-power holmium:YAG laser and vacuum-assisted, flexible, navigable access sheaths (FANS) vs. mini-percutaneous nephrolithotomy (miniPCNL) in 2–3&#xa0;cm kidney stones.</p> Methods <p>Between June 2022 and June 2024, 60 patients with 2–3&#xa0;cm in diameter kidney stones, aged 18&#xa0;years or older, were prospectively included. Patients were classified into two groups based on their decision: RIRS (Group 1) and miniPCNL (Group 2). Patient demographic data, preoperative creatinine, and hemoglobin levels were recorded. Stone-related factors were evaluated using preoperative tomography. Creatinine and hemoglobin values were measured on the first postoperative day. Stone-free status (SFRs) was evaluated on the first postoperative day and at the first month. Hospital stays and complications were assessed. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.</p> Results <p>Patient demographic data, preoperative creatinine levels, hemoglobin levels, and stone-related factors were comparable between the groups. The prestenting rate was higher in Group 1 (16.6%, 95% CI: 3.3–30) than in Group 2 (0%, 95% CI: 0–0, <i>p</i> = 0.02). The operative time and complication rates were comparable between the groups. The fluoroscopy time was lower in Group 1 (<i>p</i> &lt; 0.001). The mean hemoglobin decrease was greater in Group 2 (<i>p</i> &lt; 0.001). Stone-free status was comparable on the first day and first month. Hospital stay was shorter in Group 1 (<i>p</i> &lt; 0.001).</p> Conclusions <p>Retrograde intrarenal surgery combined with a high-power holmium:YAG laser and FANS shows comparable outcomes to miniPCNL for 2–3&#xa0;cm kidney stones, yielding a similar SFRs with lower hemoglobin decrease, shorter hospitalization time, and reduced fluoroscopy exposure. However, increased prestenting rates should be considered.</p> Trial registration <p>This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.</p>

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Comparative outcomes of flexible ureterorenoscopy with high-power holmium: YAG laser and flexible, navigable suction access sheath vs mini-percutaneous nephrolithotomy in 2–3 cm kidney stones treatment: a prospective cohort study

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  • 发表日期：

    2026年7月11日

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  • Muzaffer Tansel Kılınç,
  • Yunus Emre Göger,
  • Ömer Faruk Çavdar,
  • Hakan Hakkı Taşkapu,
  • Mehmet Serkan Özkent

摘要

Background

In this prospective controlled cohort study, we aimed to compare the safety and efficacy of Retrograde intrarenal surgery (RIRS) combined with high-power holmium:YAG laser and vacuum-assisted, flexible, navigable access sheaths (FANS) vs. mini-percutaneous nephrolithotomy (miniPCNL) in 2–3 cm kidney stones.

Methods

Between June 2022 and June 2024, 60 patients with 2–3 cm in diameter kidney stones, aged 18 years or older, were prospectively included. Patients were classified into two groups based on their decision: RIRS (Group 1) and miniPCNL (Group 2). Patient demographic data, preoperative creatinine, and hemoglobin levels were recorded. Stone-related factors were evaluated using preoperative tomography. Creatinine and hemoglobin values were measured on the first postoperative day. Stone-free status (SFRs) was evaluated on the first postoperative day and at the first month. Hospital stays and complications were assessed. This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.

Results

Patient demographic data, preoperative creatinine levels, hemoglobin levels, and stone-related factors were comparable between the groups. The prestenting rate was higher in Group 1 (16.6%, 95% CI: 3.3–30) than in Group 2 (0%, 95% CI: 0–0, p = 0.02). The operative time and complication rates were comparable between the groups. The fluoroscopy time was lower in Group 1 (p < 0.001). The mean hemoglobin decrease was greater in Group 2 (p < 0.001). Stone-free status was comparable on the first day and first month. Hospital stay was shorter in Group 1 (p < 0.001).

Conclusions

Retrograde intrarenal surgery combined with a high-power holmium:YAG laser and FANS shows comparable outcomes to miniPCNL for 2–3 cm kidney stones, yielding a similar SFRs with lower hemoglobin decrease, shorter hospitalization time, and reduced fluoroscopy exposure. However, increased prestenting rates should be considered.

Trial registration

This study was retrospectively registered to ClinicalTrials.gov (ID = NCT07349992) on January 16, 2026.