Overview
Calyceal renal calculi, specifically those located in the lower pole, are common urological findings that often require minimally invasive surgical intervention when they reach 1 to 2 cm in size 1. Management typically involves a choice between percutaneous and endoscopic approaches to achieve stone-free status while minimizing morbidity 1.Diagnosis
Imaging assessment: Evaluation of lower pole stones includes measurement of stone size (e.g., 1-2 cm) and stone-to-skin distance 1.
Laboratory evaluation: Preoperative assessment typically includes hemogram and creatinine values to establish a baseline for monitoring complications such as hemorrhage or renal function changes 1.Management
Mini Percutaneous Nephrolithotomy (Mini PCNL): A feasible minimally invasive option for 1-2 cm lower pole stones, though associated with higher morbidity 1.
Retrograde Intrarenal Surgery (RIRS): An effective alternative to Mini PCNL that offers significantly shorter hospital stays and reduced exposure to fluoroscopy 1.
Complication Profile: RIRS is associated with lower complication rates and a smaller decrease in hematocrit compared to Mini PCNL 1.
Efficacy: Both Mini PCNL and RIRS achieve comparable stone-free rates for lower pole calculi 1.
Analgesia and Recovery: Postoperative pain (measured by Visual Analog Scale) and analgesic requirements do not differ significantly between Mini PCNL and RIRS 1.
Quality of Life: Both surgical techniques lead to an increase in postoperative quality of life with no significant difference between the two modalities 1.Key Recommendations
Mini PCNL and RIRS are both feasible and effective minimally invasive treatments for 1-2 cm lower pole calyceal stones, providing similar stone-free rates (Evidence: Moderate) 1.
RIRS should be considered over Mini PCNL to reduce the duration of hospital stay and limit patient exposure to fluoroscopy (Evidence: Moderate) 1.
RIRS is recommended when the clinical priority is to minimize the risk of complications and significant postoperative hemorrhage (Evidence: Moderate) 1.References
1 Coskun A, Eryildirim B, Sarica K, Çamur E, Can U, Saglam E. Comparison of Mini Percutaneous Nephrolithotomy (Mini PCNL) and Retrograde Intrarenal Surgery (RIRS) for the Minimal Invasive Management of Lower Caliceal Stones. Urology journal 2021. link