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The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients

Carlo GiulioniDepartment of Urology, Polytechnic University of Marche, 71 Conca Street, 60126, Ancona, Italy. [email protected]Daniele CastellaniUrology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, ItalyBhaskar SomaniBen H. ChewDepartment of Urology, University of British Columbia, Vancouver, CanadaThomas TaillyDepartment of Urology, University Hospital of Ghent, Ghent, BelgiumWilliam Ong Lay KeatJeremy Yuen‐Chun TeohDepartment of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, ChinaEsteban EmilianiUrology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, SpainChu Ann ChaiDepartment of Surgery, Urology Unit, University Malaya, Kuala Lumpur, MalaysiaAndrea Benedetto GalosiUrology Unit, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona, ItalyDeepak RagooriDepartment of Urology, Asian Institute of Nephrology and Urology, Irram Manzil Colony, Hyderabad, Telangana, IndiaYılören TanıdırDepartment of Urology, Marmara University School of Medicine, Istanbul, TurkeySaeed Bin HamriDivision of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi ArabiaNariman GadzhievEndourology Department, Saint-Petersburg State Medical University, Saint-Petersburg, RussiaOlivier TraxerDepartment of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, FranceVineet GauharDepartment of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

2023en

ABI

Annotatsiya

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.

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DOI: 10.1007/s00345-023-04363-6

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