TY - JOUR

T1 - Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

AU - TOWER Group

AU - Chai, Chu-Ann

AU - Teoh, Yuen-Chun

AU - Tailly, Thomas

AU - Emiliani, Esteban

AU - Inoue, Takaaki

AU - Tanidir, Yiloren

AU - Gadzhiev, Nariman

AU - Bin Hamri, Saeed

AU - Ong, William L

AU - Shrestha, Anil

AU - Ragoori, Deepak

AU - Lakmichi, Mohamed A

AU - Gorelov, Dmitry

AU - Soebhali, Boyke

AU - Vaddi, Chandra M

AU - Bhatia, Tanuj P

AU - Desai, Devang

AU - Durai, Pradeep

AU - Heng, Chin-Tiong

AU - Chew, Ben

AU - Castellani, Daniele

AU - Somani, Bhaskar

AU - Traxer, Olivier

AU - Gauhar, Vineet

PY - 2023/8

Y1 - 2023/8

N2 - BACKGROUND: Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes.METHODS: A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded.RESULTS: Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001).CONCLUSIONS: RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

AB - BACKGROUND: Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes.METHODS: A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded.RESULTS: Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001).CONCLUSIONS: RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

KW - Humans

KW - Adolescent

KW - Adult

KW - Ureteroscopy/adverse effects

KW - Kidney Calculi/surgery

KW - Nephrostomy, Percutaneous/adverse effects

KW - Treatment Outcome

KW - Ureteral Calculi/surgery

U2 - https://doi.org/10.23736/s2724-6051.23.05239-4

DO - https://doi.org/10.23736/s2724-6051.23.05239-4

M3 - Article

C2 - 37293816

VL - 75

SP - 493

EP - 500

JO - Minerva Urologica

JF - Minerva Urologica

SN - 0393-2249

IS - 4

ER -