Perri Davide, Besana Umberto, Maltagliati Matteo, Pacchetti Andrea, Calcagnile Tommaso, Pastore Antonio Luigi, Romero-Otero Javier, Micali Salvatore, Govorov Alexander, Somani Bhaskar, Liatsikos Evangelos, Knoll Thomas, Rocco Bernardo, Bozzini Giorgio
Department of Urology, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy.
Department of Urology, Sapienza University, Rome, Italy.
BJU Int. 2025 Mar;135(3):497-501. doi: 10.1111/bju.16585. Epub 2024 Nov 19.
To assess differences in bleeding risk between retrograde intrarenal surgery (RIRS) and minimally invasive miniaturised percutaneous nephrolithotomy (mini-PCNL) for 10-20 mm renal stones.
A total of 176 patients with a renal stone between 10 and 20 mm were treated. For all patients the Stone Management According to Size-Hardness (SMASH) score was calculated: Hounsfield units × stone maximum size (cm)/100. Patients with score of <15 underwent RIRS (90 patients, Group A), whereas patients with score ≥15 underwent mini-PCNL (86 patients, Group B). In both groups the Cyber Ho laser was used. A statistical analysis was carried out to assess differences in the risk of bleeding.
Preoperative features were comparable. The mean maximum stone diameter was 17.1 and 16.8 mm in Groups A and B, respectively (P = 0.13). The stone-free rate was comparable (87.8% vs 95.3%, P = 0.07). The overall complication rate was 14.4% and 18.6% in Groups A and B, respectively (P = 0.09). Gross haematuria was observed in five cases (5.5%) after RIRS and seven (8.1%) after mini-PCNL (P = 0.07). The mean haemoglobin drop was 12 and 2 g/L at the first and third postoperative day after RIRS vs 17 and 3 g/L after mini-PCNL (P = 0.06 and P = 0.21, respectively). Blood transfusions and renal embolisation were never necessary.
When managing renal stones between 10 and 20 mm taking into account both size and hardness with the application of the SMASH score, RIRS and mini-PCNL show comparable efficacy. A higher bleeding risk has been expected with percutaneous approaches; however, in our cohort the incidence of clinically significant bleeding was low and comparable between the two groups when adopting mini-PCNL.
评估逆行性肾内手术（RIRS）与微创小型化经皮肾镜取石术（mini-PCNL）治疗10 - 20毫米肾结石时出血风险的差异。
共治疗176例肾结石直径在10至20毫米之间的患者。为所有患者计算结石大小硬度管理（SMASH）评分：亨氏单位×结石最大直径（厘米）/100。评分<15的患者接受RIRS（90例，A组），而评分≥15的患者接受mini-PCNL（86例，B组）。两组均使用赛博Ho激光。进行统计分析以评估出血风险的差异。
术前特征具有可比性。A组和B组的平均最大结石直径分别为17.1毫米和16.8毫米（P = 0.13）。结石清除率具有可比性（87.8%对95.3%，P = 0.07）。A组和B组的总体并发症发生率分别为14.4%和18.6%（P = 0.09）。RIRS术后5例（5.5%）出现肉眼血尿，mini-PCNL术后7例（8.1%）出现肉眼血尿（P = 0.07）。RIRS术后第1天和第3天血红蛋白平均下降分别为12克/升和2克/升，mini-PCNL术后分别为17克/升和3克/升（分别为P = 0.06和P = 0.21）。从未需要输血和肾栓塞。
在应用SMASH评分综合考虑大小和硬度来处理10至20毫米的肾结石时，RIRS和mini-PCNL显示出相当的疗效。经皮手术方法预期出血风险更高；然而，在我们的队列中，当采用mini-PCNL时，临床显著出血的发生率较低且两组相当。
