JCM, Vol. 15, Pages 177: Comparison Between RIRS and Mini-PCNL in the Treatment of Kidney Stones Exceeding 15 mm: Outcome Evaluation and Cost Analysis

Journal of Clinical Medicine doi: 10.3390/jcm15010177

Authors:
Paolo Pietro Suraci
Andrea Fuschi
Manfredi Bruno Sequi
Fabio Maria Valenzi
Alice Antonioni
Onofrio Antonio Rera
Yazan Al Salhi
Damiano Graziani
Giorgio Martino
Giuseppe Candita
Filippo Gianfrancesco
Paolo Benanti
Cosimo De Nunzio
Giorgio Bozzini
Michele Di Dio
Pierluigi Russo
Matteo Pacini
Carlo Introini
Antonio Carbone
Antonio Luigi Pastore

Background/Objectives: The optimal surgical approach for kidney stones (KS) measuring 15–20 mm remains debated. RIRS and mini-PCNL are both effective options, but they differ in invasiveness, resource use, and cost. This study aimed to compare perioperative outcomes and hospital costs of RIRS and mini-PCNL using a micro-costing approach. Methods: This retrospective study included patients with KS > 15 mm in diameter who were treated between January 2021 and December 2023 at the Department of Urology, Sapienza University of Rome-Polo Pontino. Clinical parameters, operative time (OT), length of stay (LoS), complications, and stone-free rate (SFR) were compared. Costs were estimated using a micro-costing method, including disposable materials, operating room (OR) time (3.9 EUR/min), imaging, and hospitalization (334 EUR/day). The total cost per treated and per SF patient was calculated for both techniques. Results: A total of 119 patients were analyzed: 62 underwent RIRS, and 57 underwent mini-PCNL. Mean OT was shorter for RIRS (87 vs. 113 min; p < 0.001), and LoS was longer for mini-PCNL (2.24 vs. 1.22 days; p = 0.008). Final SFR was higher for mini-PCNL (94.7% vs. 88.7%; p = 0.043). Complication rates were comparable, with most events classified as Clavien–Dindo I–II. Disposable materials represented the main cost driver (EUR 1097 for RIRS vs. EUR 806 for mini-PCNL). The total cost per treated patient was EUR 3689 for RIRS and EUR 3154 for mini-PCNL (p = 0.009). The cost per SF patient was EUR 4159 for RIRS and EUR 3331 for mini-PCNL (p = 0.007). Conclusions: Both RIRS and mini-PCNL are safe and effective for the management of KS ≥ 15 mm. Mini-PCNL achieves higher SFR and greater cost-efficiency than RIRS. These findings support the use of mini-PCNL as the preferred option in centers with adequate expertise and resources.

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