ObjectiveTo assess differences in bleeding risk between retrograde intrarenal surgery (RIRS) and minimally invasive miniaturised percutaneous nephrolithotomy (mini‐PCNL) for 10–20 mm renal stones.Patients and methodsA 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.ResultsPreoperative 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.ConclusionWhen 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.

中文翻译：

---

10-20 mm 肾结石逆行肾内手术后出血风险与小型经皮肾镜取石术：安全性差异不大


目的评估逆行肾内手术 （RIRS） 和微创小型经皮肾镜取石术 （mini-PCNL） 治疗 10-20 mm 肾结石的出血风险差异。患者和方法共治疗 176 例肾结石在 10 至 20 mm 之间的患者。对于所有患者，根据大小-硬度进行结石管理 （SMASH） 评分计算：Hounsfield 单位×结石最大尺寸 （cm）/100。评分为 <15 的患者接受了 RIRS （90 例患者，A 组），而评分为 ≥15 的患者接受了 mini-PCNL （86 例患者，B 组）。在两组中都使用 Cyber Ho 激光。进行统计分析以评估出血风险的差异。结果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 和 16.8 毫米 （P = 0.13）。结石清除率相当 （87.8% vs 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 后 5 例 （5.5%） 和 mini-PCNL 后 7 例 （8.1%） 观察到肉眼血尿 （P = 0.07）。RIRS 术后第 1 天和第 3 天的平均血红蛋白下降分别为 12 和 2 g/L，而 mini-PCNL 后分别为 17 和 3 g/L （分别为 P = 0.06 和 P = 0.21）。输血和肾栓塞术从来都不是必要的。结论当管理 10 至 20 mm 之间的肾结石时，同时考虑大小和硬度并应用 SMASH 评分，RIRS 和 mini-PCNL 显示出相当的疗效。经皮入路预计出血风险更高;然而，在我们的队列中，采用 mini-PCNL 时，两组之间临床显着出血的发生率较低且相当。