Introduction:Success of any modality for stone disease needs to be evaluated in terms of Stone Free Rates (SFR), auxiliary procedures needed; complications and follow up. SFR in RIRS is subject to parameters like stone burden, location, number, hardness, composition; calyceal and ureter anatomy; use of ureteric access sheath (UAS); surgeon experience etc.Methods:The aim of this study is to evaluate the efficacy and safety of RIRS for managing upper tract stones. The objectives include evaluating SFR in RIRS in relation to stone burden, location and number. Other objectives include evaluating SFR after re RIRS in relation to stone burden, necessity of pre DJ stenting, use of UAS and post operative complication rate. 131 patients operated by single surgeon for single/multiple renal and/or upper ureteric stones were evaluated. Stone size > 3 mm on follow up CT KUB was considered as residual. Re RIRS was required for residual stones.Results:The overall SFR was 76%. SFR were statistically lower with stone burden > 1.5 cm, lower calyceal stones and single stones with stone burden > 1.5 cm. SFR was 90% after 2nd RIRS and 98.5% after 3rd RIRS procedure. No significant difference in SFR was noted between single v/s multiple stones, single calyx v/s multiple calyx stones and renal v/s upper ureteric stones. No major complication was noted.Conclusion:Larger stone burden and lower calyceal location are important factors deciding SFR in RIRS. With auxiliary procedure, RIRS is safe and effective compared to PCNL.
Purpose:
Infective complications such as fever, systemic inflammatory response syndrome (SIRS), septicemia, and shock are common and preventable complications after retrograde intrarenal surgery (RIRS). Patients with positive urine and stone cultures have a greater risk of SIRS. Infection stones (carbonate apatite) are bacteria-harboring stones that predispose to sepsis. A pilot study is conducted to establish the role of stone analysis in predicting SIRS after RIRS compared to urine and stone cultures.
Materials and Methods:
Sixty patients who underwent RIRS from January 2018 to June 2018 were prospectively evaluated with respect to preoperative urine culture, stone burden and location, operative time, postoperative clinical course, residual stone size, stone culture, stone analysis, and occurrence of septicemia-related events.
Results:
5 out of 60 patients who underwent RIRS developed SIRS (8%). Sensitivity levels of predicting SIRS were different, where urine culture (20%), stone culture (20%), and carbonate apatite on the stone analysis (60%). Positive urine culture and stone culture had no significant relation to the prediction of SIRS (P = 1). Carbonate apatite was present in 12 samples (20%) in varying proportions. The presence of apatite >50% of the total sample was in 5/60 samples (8%), which are referred to as infection stones. Three out of these 5 patients with infection stones developed SIRS (60%). Thus, the presence of carbonate apatite in the stone analysis had a statistically significant relation to SIRS (P < 0.01).
Conclusion:
The presence of carbonate apatite >50% on stone analysis has higher sensitivity than urine and stone culture in predicting SIRS after RIRS.
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