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.