TY - JOUR

T1 - The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones

T2 - results from 2946 patients

AU - Giulioni, Carlo

AU - Castellani, Daniele

AU - Somani, Bhaskar Kumar

AU - Chew, Ben Hall

AU - Tailly, Thomas

AU - Keat, William Ong Lay

AU - Teoh, Jeremy Yuen-Chun

AU - Emiliani, Esteban

AU - Chai, Chu Ann

AU - Galosi, Andrea Benedetto

AU - Ragoori, Deepak

AU - Tanidir, Yiloren

AU - Hamri, Saeed Bin

AU - Gadzhiev, Nariman

AU - Traxer, Olivier

AU - Gauhar, Vineet

N1 - © 2023. The Author(s).

PY - 2023/5

Y1 - 2023/5

N2 - PURPOSE: To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR).METHODS: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05.RESULTS: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF.CONCLUSIONS: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

AB - PURPOSE: To evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR).METHODS: Data from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05.RESULTS: 2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF.CONCLUSIONS: RIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

KW - Adult

KW - Humans

KW - Kidney Calculi/surgery

KW - Retrospective Studies

KW - Lipopolysaccharides

KW - Lithotripsy/methods

KW - Ureteral Calculi/surgery

KW - Treatment Outcome

U2 - 10.1007/s00345-023-04363-6

DO - 10.1007/s00345-023-04363-6

M3 - Article

C2 - 36930255

VL - 41

SP - 1407

EP - 1413

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

IS - 5

ER -