To compare percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for the treatment of lower calyceal calculi with diameter of 2-3 cm in patients with solitary kidney.

We retrospectively analyzed 76 cases of calculi in solitary kidney from 3 medical centers in China between April 2013 and October 2016. Among them, 42 cases underwent PCNL, and 34 cases underwent RIRS.

The operation time of the PCNL group (82.0 ± 27.9 minutes) was shorter than the RIRS group (117.2 ± 23.1 min, P <.001). The intraoperative decrease in hemoglobin of the PCNL group was 5.4 ± 2.3 g/L, which was significantly higher than the RIRS group (1.8 ± 0.5 g/L, P <.001). The postoperative hospital stay was 13.9 ± 1.6 days for PCNL, which was longer than the RIRS group (7.3 ± 1.2 days, P < .001). PCNL achieved 85.7% (36 of 42) on 1-session stone-free rate, whereas RIRS group was 58.8% (20 of 34, P = .008). The overall stone-free rates were 92.86% (39 of 42) and 85.29% (29 of 34) for PCNL and RIRS, respectively (P >.05). The postoperative complication rate was similar between the RIRS group and the PCNL group.

For patients with solitary kidney, PCNL achieved a higher 1-session stone-free rate than RIRS in the treatment of lower calyceal calculi within 2-3 cm in diameter. However, RIRS, with less bleeding and shorter postoperative hospital stay, may be an alternative.