title: Is RIRS emerging as the preferred option for the management of 2 cm-4 cm renal stones: our experience.
abstract: BACKGROUND
  The European Association of Urology (EAU) and the American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) as the first-line treatment of renal stones greater than 20 mm, however multistage retrograde intrarenal stone surgery (RIRS) is reported to have high stone-free rates (SFR), fewer complications and a rapid learning curve. This study presents our experience of RIRS in the management of 2 cm-4 cm renal stones.
  
  
  METHODS
  A retrospective study was performed of all patients who underwent RIRS for 2 cm-4 cm renal stones over a period of 22 months. The demographics of 71 patients as well as the stone and procedural demographics were recorded. Pre and postoperative radiological assessment was performed by NCCT scanning in 83% of the patients and ureteral access sheaths were used in only 12% of the patients. The severity of surgical complications was determined according to the Clavien-Dindo system.
  
  
  RESULTS
  RIRS was performed on 71 patients for renal stones with a mean size of 26 mm. The mean number of procedures per patient was 2.1 and the overall SFR was 81%. Few complications were encountered and only 1 patient had III-b Clavien complication.
  
  
  CONCLUSIONS
  The study further supports RIRS as a safe and efficacious treatment option for renal stones of 2 cm-4 cm in size. Although both the EAU and AUA do not currently recommend RIRS as the first-line treatment of such stones, it appears to be emerging as a commonly utilized primary modality.
authors.affiliation: Department of Urology, Royal Hospital, Muscat, Oman.
authors.forename: Salim Said
authors.initials: SS
authors.lastname: Al Busaidy
authors.forename: Santhosh Narayana
authors.initials: SN
authors.lastname: Kurukkal
authors.forename: Qais Mohamed
authors.initials: QM
authors.lastname: Al Hooti
authors.forename: Mohammed Sdky
authors.initials: MS
authors.lastname: Alsaraf
authors.forename: Said Abdallah
authors.initials: SA
authors.lastname: Al Mamari
authors.forename: Ahmed Khamis
authors.initials: AK
authors.lastname: Al Saeedi
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000473:pathology; D053844:Lasers, Solid-State / Q000627:therapeutic use; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods; D009850:Oman / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D018666:Ureteroscopy / Q000379:methods*