Introduction
Currently, retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the most favored treatment options for renal stones.1 According to EAU guideline, PCNL is the standard treatment for renal stones > 2 cm, and RIRS and shock wave lithotripsy ( SWL) for renal stones < 2cm.2 However, despite the recommendations of the EAU guideline on management of renal stones, RIRS has been widely used to treat renal stones > 2 cm by several investigators.3,4 So, for renal stone between 10 and 30 mm, RIRS and PCNL are both options, and the choice of treatment will depend on anatomical and stone characteristics. However, surgical complications are associated with PCNL, therefore, for elderly patients, minimally invasive procedures, especially RIRS, are preferable. On the other hand, PCNL has an excellent success rate in clearing stone burdens, at reported rates of up to 96.1%.5 The stone-free rate (SFR) for RIRS has been reported as 77% to 96.7 % with staged procedures for renal stones > 2 cm.6 Therefore, urologists have to make a difficult decision regarding the technical that should be preferred in geriatric patients with low cardiopulmonary performance and kidney reserves.
There are several comorbidity indices in the medical literature but Charlson comorbidity index (CCI) is widely used.7-9The CCI uses 19 comorbid conditions to predict mortality. In this method, patients are given a score or weight from 1 to 6, according to comorbid condition.7 Although CCI is designed to show mortality risk, its parameters (diabetes mellitus, cardiac disease, age, etc.) are related to surgical morbities.
In this study, we aimed to compare the outcomes of PCNL and RIRS in treating renal stones of between 10 and 30 mm in geriatric patients. To our knowledge, this is the first study of the effect of CCI on complications and outcomes in elderly patients following PCNL and RIRS.