Evidence map›Paper›PMID 41385038›Full record

Trial reportInternational urology and nephrology2026

Prospective randomized trial comparing mini-percutaneous nephrolithotomy, retrograde intrarenal surgery, and shock wave lithotripsy for treatment of medium-sized high-density renal stones.

Abul-Fotouh Ahmed, Mohammed Raafat, Hany ElDamanhory, Hassan Abdelazim, Ahmed Soliman, Ahmed ElShazly, Mohammed Hindawy, Mohammed Anwar, Mohamed Algammal, Awatef Soliman and 1 more

Registry-linked trialAbstract readRandomized Controlled TrialComparative Study
PubMed Publisher
In one paragraph

Trial report in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04856722 (Mini-PNL, RIRS, and ESWL for Treatment of Medium-Sized, High-Density, Non-Lower Pole, Renal Stones), which is not on this map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04856722 nacompletednot on this map

Mini-PNL, RIRS, and ESWL for Treatment of Medium-Sized, High-Density, Non-Lower Pole, Renal Stones: A Prospective, Randomized, Comparative Study

TypeinterventionalSponsorAl-Azhar UniversityRan2021 to 2025Enrolled253ConditionsRenal Stone, Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery, Extracorporeal Shockwave LithotripsyArmsmini-PNL, RIRS, SWL
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Abul-Fotouh AhmedDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt. abulfotouhahmed@yahoo.com.ORCID https://orcid.org/0000-0001-5137-8095
Mohammed RaafatDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Hany ElDamanhoryDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Hassan AbdelazimDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Ahmed SolimanDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Ahmed ElShazlyDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Mohammed HindawyDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Mohammed AnwarDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Mohamed AlgammalDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.
Awatef SolimanDepartment of Clinical Pathology, Abukhalifa Emergency Hospital, Egyptian Healthcare Insurance Authority, Ismailia, Egypt.
Abdullah DaoudDepartment of Urology, Faculty of Medicine, Al-Azhar University, Cairo, 11633, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo compare the efficacy and safety of different treatment modalities, mini-percutaneous nephrolithotomy (mini-PNL), retrograde intrarenal surgery (RIRS), and extracorporeal shock wave lithotripsy (SWL), for the management of medium-sized, high-density, non-lower-pole renal stones.

methodsBetween November 2021 and March 2025, adults with single renal stones of 10-20 mm and ≥ 1000 HU were prospectively randomized to mini-PNL, RIRS, or SWL. Procedures were performed by experienced endourologists using standardized protocols. The primary outcome was stone-free rate (SFR) at 3 months, defined as no residual fragments > 4 mm on NCCT. Secondary outcomes included operative and fluoroscopy times, hospital stay, retreatment, perioperative complications, and treatment costs. Analyses followed the intention-to-treat principle.

resultsOf 330 enrolled patients, 304 completed the study (mini-PNL, n = 105; RIRS, n = 103; SWL, n = 96). Final SFRs were 96.2% for mini-PNL, 91.3% for RIRS, and 51.0% for SWL. Both mini-PNL and RIRS achieved significantly higher SFRs than SWL (p < 0.001), with mini-PNL demonstrating superior single-session clearance. Operative time was shortest with SWL, fluoroscopy exposure was lowest with RIRS, and hospital stay was shortest with RIRS, while SWL was performed on an outpatient basis. Overall complications were 11.4% (mini-PNL), 22.3% (RIRS), and 16.7% (SWL), with no significant differences (p = 0.109) or in high-grade events (p = 0.879). Median treatment costs per stone-free patient were 24,121 EGP for mini-PNL, 57,100 EGP for RIRS, and 23,843 EGP for SWL.

conclusionsIn conclusion, mini-PNL and RIRS are more effective than SWL, with mini-PNL offering the best balance of efficacy and safety, and RIRS a less invasive but more costly option. REGISTRY: ClinicalTrials.gov, TRN: NCT04856722, Registration date: 21 April 2021.

Indexed as

Kidney CalculiLithotripsyNephrolithotomy, PercutaneousAdultAgedFemaleHumansMaleMiddle AgedProspective StudiesTreatment OutcomeExtracorporeal shock wave lithotripsyHigh-densityMini-percutaneous nephrolithotomyNon-lower-poleRenal stonesRetrograde intrarenal surgery

Identifiers

PMID41385038

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.