Background/Objectives: The optimal surgical approach for kidney stones (KS) measuring 15-20 mm remains debated. RIRS and mini-PCNL are both effective options, but they differ in invasiveness, resource use, and cost. This study aimed to compare perioperative outcomes and hospital costs of RIRS and mini-PCNL using a micro-costing approach. Methods: This retrospective study included patients with KS > 15 mm in diameter who were treated between January 2021 and December 2023 at the Department of Urology, Sapienza University of Rome-Polo Pontino. Clinical parameters, operative time (OT), length of stay (LoS), complications, and stone-free rate (SFR) were compared. Costs were estimated using a micro-costing method, including disposable materials, operating room (OR) time (3.9 EUR/min), imaging, and hospitalization (334 EUR/day). The total cost per treated and per SF patient was calculated for both techniques. Results: A total of 119 patients were analyzed: 62 underwent RIRS, and 57 underwent mini-PCNL. Mean OT was shorter for RIRS (87 vs. 113 min; p < 0.001), and LoS was longer for mini-PCNL (2.24 vs. 1.22 days; p = 0.008). Final SFR was higher for mini-PCNL (94.7% vs. 88.7%; p = 0.043). Complication rates were comparable, with most events classified as Clavien-Dindo I-II. Disposable materials represented the main cost driver (EUR 1097 for RIRS vs. EUR 806 for mini-PCNL). The total cost per treated patient was EUR 3689 for RIRS and EUR 3154 for mini-PCNL (p = 0.009). The cost per SF patient was EUR 4159 for RIRS and EUR 3331 for mini-PCNL (p = 0.007). Conclusions: Both RIRS and mini-PCNL are safe and effective for the management of KS ≥ 15 mm. Mini-PCNL achieves higher SFR and greater cost-efficiency than RIRS. These findings support the use of mini-PCNL as the preferred option in centers with adequate expertise and resources.
Journal of clinical medicine. 2025 Dec 26*** epublish ***
Paolo Pietro Suraci, Andrea Fuschi, Manfredi Bruno Sequi, Fabio Maria Valenzi, Alice Antonioni, Onofrio Antonio Rera, Yazan Al Salhi, Damiano Graziani, Giorgio Martino, Giuseppe Candita, Filippo Gianfrancesco, Paolo Benanti, Cosimo De Nunzio, Giorgio Bozzini, Michele Di Dio, Pierluigi Russo, Matteo Pacini, Carlo Introini, Antonio Carbone, Antonio Luigi Pastore
Urology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, 04100 Latina, Italy., Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy., Department of Urology, ASST Lariana-Sant'Anna Hospital, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy., Division of Urology, Department of Surgery, Annunziata Hospital, 87100 Cosenza, Italy., Department of Urology, IRCCS A. Gemelli University Polyclinic Foundation, 00168 Rome, Italy., Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy., Urology Unit, Department of Abdominal Surgery, E.O. Ospedali Galliera, 16128 Genoa, Italy.