الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
The management of renal calculi has changed dramatically in the last 25 years. In the modern era nearly all urinary calculi are treated with minimally invasive techniques, which include percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS).
When choosing the most appropriate treatment modality three main factors needed to be considered are stone parameters, patient factors and surgeon factors including comfort with endourological procedure.
The American Urological Association and European Association of Urology have established recommendations based on stone size and location. Renal stones smaller than 10 mm, independent of location, can be treated with SWL or RIRS, with PNL as second line therapy. For stones larger than 20 mm, PNL is recommended as first line therapy, with RIRS and SWL as second line options. Stones 10 to 20 mm can be treated with any modality, depending on the stone location.
Mini PCNL is postulated to be less invasive than standard PCNL with decreased hemoglobin drop, less requirement of analgesics, shorter hospital stay and comparable stone free rates. Therefore, mini PCNL is a safe and efficient solution for large renal stones.
Many studies have reported that RIRS can be performed efficiently and safely for stones >2 cm. Several factors contributed to the increasing role of RIRS, including significant advances in flexible ureteroscope design and functionality the invention of newer smaller flexible ureteroscopes with greater degrees of deflection, improving access to all areas within the collecting system. Advances such as the ureteral access sheath provide straight forward renal access. Better laser fibers, improved laser technology and nitinol baskets allow for safe and expeditious removal of stone fragments.
The current prospective randomized study aimed to evaluate the efficacy and safety of mini percutaneous nephro-Lithotripsy (mini PCNL) and retrograde intrarenal surgery (RIRS) in treatment of renal stones 20mm or larger in its longest diameter using holmium: YAG laser after reviewing the evolution of modern RIRS and mini PCNL
CONCLUSION
In patients with renal stones 20 mm or larger, the current study showed that mini PNCL has higher but comparable stone free rate and shorter operative time than RIRS in expense of higher complications rate, blood loss, and longer hospital stay.
Both techniques are safe and effective with no superiority of one over the other. They can be alternative and complementary to each other in failed cases.
In many clinical scenarios for treatment, there may be more than one reasonable approach, and the choice of surgical approach is dictated by patient factors and surgeon practice patterns .Therefore, it is advisable to weigh the benefits and risks of each technique according to the previously mentioned characteristics and choose the optimal option for patients.