Robot-assisted laparoscopic pyelolithotomy versus multiple-tract mini-percutaneous nephrolithotomy for moderate-to-complex kidney stones: a propensity score-matched retrospective study.

Large and complex kidney stones remain difficult to treat, particularly when stones extend into several calyces. RLPL provides access to the collecting system without renal parenchymal puncture, whereas multiple-tract Mini-PCNL relies on several percutaneous tracts to reach different stone-bearing areas. We retrospectively analyzed patients with moderate-to-complex kidney stones treated with either procedure between January 2017 and December 2025. Propensity score matching was used to reduce baseline differences between groups. The main endpoint was stone-free status at 3 months; perioperative outcomes and complications were also recorded. Among 153 eligible patients, 108 received multiple-tract Mini-PCNL and 45 underwent RLPL. Matching produced 35 pairs. At 3 months, stone-free status was achieved in 71.4% of patients undergoing RLPL and 68.6% of those undergoing multiple-tract Mini-PCNL, with no significant difference detected between groups (risk difference 2.9%, 95% CI: -22.9% to 22.9%; P = 1.000). RLPL demonstrated significantly less hemoglobin drop but required longer operative time and postoperative hospitalization. Overall complication rates were 20.0% and 17.1%, respectively (P = 1.000). On exploratory multivariable analysis, residual stones were independently associated with higher BMI and larger stone diameter, whereas surgical approach was not an independent predictor. RLPL may serve as a complementary option for selected patients with complex kidney stones rather than a replacement for multiple-tract Mini-PCNL.