Comparative Analysis of Surgical Outcomes Between Robotic-Assisted Pyelolithotomy and Mini-Percutaneous Nephrolithotomy for Renal Stones Larger Than 2 cm in Older Adults: A One-Year Follow-Up Study

PURPOSE: This study aimed to compare the surgical outcomes of robotic-assisted pyelolithotomy (RAPL) and mini-percutaneous nephrolithotomy (mini-PCNL) specifically in older adults with renal stones more than 2cm. We hypothesized that robotic-assisted pyelolithotomy (RAPL) is a safe and effective approach for managing large renal stones (>2 cm) in older adults.

PATIENTS AND METHODS: We retrospectively analyzed 605 patients aged 50-80 years who underwent either RAPL (n=31) or mini-PCNL (n=574) for renal stones >2 cm at Chang Gung Memorial Hospital, Taiwan, between December 2016 and November 2023. Patients were selected based on predefined inclusion and exclusion criteria. Key outcomes measured included stone-free rate, complication rate, hospital stay duration, and re-intervention rates. All patients were followed for at least one year postoperatively.

RESULTS: RAPL patients exhibited a longer total operative time (165.2 vs 127.4 minutes, p = 0.016) but experienced significantly shorter hospital stays (1.8 vs 4.0 days, p < 0.001), lower complication rates (6.5% vs 27.7%, p < 0.05), and higher SFRs (90.3% vs 60.8%, p < 0.001). Blood transfusion, postoperative discomfort, and re-intervention rates were also markedly lower in the RAPL group.

CONCLUSION: For older patients with large renal stones, RAPL is a promising alternative to mini-PCNL, offering better stone clearance, fewer complications, and quicker recovery. Its minimally invasive, tissue-sparing approach benefits those at higher postoperative risk.