Background: Minimally Invasive Percutaneous Nephrolithotomy (mini-PCNL) and Retrograde Intrarenal Surgery (RIRS) are widely used treatment modalities for renal stones measuring 10–20 mm. While mini-PCNL is associated with high stone clearance rates, RIRS offers a less invasive approach with faster postoperative recovery. Current evidence comparing the effectiveness and safety of these procedures remains inconsistent.

Methods: A systematic review and meta-analysis was conducted according to PRISMA guidelines. Electronic databases were searched for comparative studies evaluating mini-PCNL and RIRS in patients with renal calculi. Outcomes of interest included stone-free rate (SFR), length of hospital stay (LOS), operative time, and overall complications. Pooled analyses were performed using random-effects models and reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs).

Results: Thirteen studies involving 1,694 patients met the inclusion criteria. Meta-analysis demonstrated a significantly higher stone-free rate with mini-PCNL compared with RIRS (RR=0.95; 95% CI 0.92–0.98; p=0.001). Conversely, RIRS was associated with a significantly shorter hospital stay (MD=-2.05 days; 95% CI -2.72 to -1.38; p<0.00001) and a lower overall complication rate (RR=0.75; 95% CI 0.62–0.92; p=0.005). No significant difference was observed in operative time between the two procedures (MD=2.98 minutes; 95% CI -13.24 to 19.19; p=0.72).

Conclusion: Mini-PCNL achieves superior stone-free outcomes compared with RIRS. However, RIRS provides advantages in terms of shorter hospitalization and lower complication rates. Treatment selection should therefore be individualized according to the balance between maximizing stone clearance and minimizing perioperative morbidity.