What question did this study set out to answer?

This study examines the effectiveness and safety of RIRS with a high-power laser compared to mini-PCNL for kidney stones of 2–3 cm.

July 13, 2026Open Access

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

MKMuzaffer Tansel KılınçSelçuk University YGYunus Emre GöğerNecmettin Erbakan University OCOmer CavdarTongji University

Key Points

This study examines the effectiveness and safety of RIRS with a high-power laser compared to mini-PCNL for kidney stones of 2–3 cm.
Prospective cohort design with 60 patients
Groups: RIRS with high-power holmium:YAG laser vs mini-PCNL
Measured outcomes include stone-free status, hospital stay, and complications.
Prestenting rate was significantly higher in RIRS (16.6%, 95% CI: 3.3–30) vs mini-PCNL (0%, 95% CI: 0–0, p = 0.02)
RIRS demonstrated shorter hospital stays (p < 0.001) and lower fluoroscopy time (p < 0.001)
Mean hemoglobin decrease was greater in mini-PCNL (p < 0.001) while stone-free status was comparable.

Abstract

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

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