Статья

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

Chu Ann ChaiUnit of Urology, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia - [email protected]on behalf of the TOWER GroupS.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, ChinaYuen-Chun TEOHS.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, ChinaThomas TaillyDepartment of Urology, University Hospital of Ghent, Ghent, BelgiumEsteban EmilianiPuigvert Foundation, Autonomous University of Barcelona, Barcelona, SpainTakaaki InoueHara Genitourinary Private Hospital, University of Kobe, Kobe, JapanYılören TanıdırDepartment of Urology, School of Medicine, Marmara University, Istanbul, TürkiyeNariman GadzhievDepartment of Urology, Saint Petersburg State University Hospital, Saint Petersburg, RussiaSaeed Bin HamriDivision of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi ArabiaWilliam L. ONGDepartment of Urology, Penang General Hospital, Penang, MalaysiaAnil ShresthaNational Academy of Medical Sciences, Bir Hospital, Kathmandu, NepalDeepak RagooriAsian Institute of Nephrology and Urology, Hyderabad, IndiaMohamed Amine LakmichiDepartment of Urology, University Hospital Mohammed VI of Marrakesh, Cadi Ayyad University, Marrakesh, MoroccoD. S. GorelovDepartment of Endourology, Saint-Petersburg State Medical University, Saint-Petersburg, RussiaBoyke SoebhaliFaculty of Medicine, Abdul Wahab Sjahranie Hospital, Mulawarman University, Mulawarman, IndonesiaChandra Mohan VaddiTanuj BhatiaDepartment of Urology, Sarvodaya Healthcare, Faridabad, Haryana, IndiaDevang DesaiDepartment of Urology, Toowoomba Base Hospital, Toowoomba, AustraliaPradeep DuraiDepartment of Urology, Ng Teng Fong General Hospital, Singapore, SingaporeChin-Tiong HengDepartment of Urology, Ng Teng Fong General Hospital, Singapore, SingaporeBen H. ChewDepartment of Urology, University of British Columbia, Vancouver, BC, CanadaDaniele CastellaniDepartment of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UKBhaskar SomaniDepartment of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UKOlivier TraxerDepartment of Urology, GRC Urolithiasis, Tenon Hospital, Sorbonne University, Paris, FranceVineet GauharDepartment of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

2023en

ABI

Аннотация

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.

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Идентификаторы

DOI: 10.23736/s2724-6051.23.05239-4

Цитирования и источники

Цитирований: 2Использованных источников: 0

Показатели — AkademScholar