Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review

Leah Soderberg, Onuralp Ergun, Maylynn Ding, Robin Parker, Michael Borofsky, Vernon Pais, Philipp Dahm

Research output: Contribution to journalReview articlepeer-review


Objectives: To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults. Methods: We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk-of-bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co-publication focuses on the primary outcomes of this review only. Results: We included 42 trials that met the inclusion criteria. Stone-free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08–1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59–1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17–0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS. Conclusion: Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.

Original languageEnglish (US)
Pages (from-to)132-140
Number of pages9
JournalBJU International
Issue number2
StatePublished - Feb 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.


  • kidney stone
  • percutaneous nephrolithotomy
  • retrograde intrarenal surgery
  • stone treatment
  • ureteroscopy

PubMed: MeSH publication types

  • Journal Article
  • Review

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