Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

Abstract

Objective:The aim of the study was to evaluate renal function and to identify factors associated with renal function deterioration after retrograde intrarenal surgery (RIRS) for kidney stones.Materials and Methods:We retrospectively analyzed patients with renal stones treated by RIRS between January 2010 and June 2013 at a single institute. We used the National Kidney Foundation classification of chronic kidney disease (CKD) to classify Glomerular Filtration Rate (GFR) in 5 groups. The baseline creatinine level was systematically pre-operatively and post-operatively evaluated. All patients had a creatinine blood measurement in June 2013. A change toward a less or a more favorable GFR group following RIRS was considered significant.Results:We included 163 patients. There were 86 males (52.8%) and 77 females (47.3%) with a mean age of 52.8±17 years. After a mean follow-up of 15.5±11.5 months, median GFR was not significantly changed from 84.3±26.2 to 84.9±24.5 mL/min (p=0.675). Significant renal function deterioration occurred in 8 cases (4.9%) and significant renal function amelioration occurred in 23 cases (14.1%). In univariate analysis, multiple procedures (p=0.023; HR: 5.4) and preoperative CKD (p=0.011; HR: 6.8) were associated with decreased renal function. In multivariate analysis these factors did not remain as predictive factors.Conclusion:Stone management with RIRS seems to have favorable outcomes on kidney function; however, special attention should be given to patients with multiple procedures and preoperative chronic kidney disease.

Postoperative renal functional changes assessed by 99mTc-DTPA scintigraphy and predictive factors after miniaturized percutaneous nephrolithotomy and retrograde intrarenal surgery: An observational 1-year follow-up study

“…Although overall postoperative renal functional outcomes were stable, six patients in the RIRS and four patients in the mini-PCNL group showed renal deterioration. Because PCNL and RIRS are known to ensure the safety of kidney function postoperatively [18,23], further evaluation of the safety and efficacy of minimally invasive renal stone surgery during a long-term follow-up is needed, especially in patients with preoperative renal insufficiency. Finally, it is hard to clarify whether the deterioration in renal function was induced by surgery or was associated with the natural history of stone disease.…”

Retrograde Intrarenal Surgery or Shock Wave Lithotripsy?: Comparison of the Effects on Renal Functions by Glomerular Filtration Rate

“…SWL is a less invasive treatment modality compared to RIRS, however, RIRS seems to have higher success and lower re-treatment rates (18). All these interventions affect the renal function and there are fewer studies evaluating and comparing these aspects (10,19,20).…”

“…On the other hand, both of them may cause a minimal decline in renal function. During SWL, shock wave energy may damage the renal parenchyma and during RIRS procedure, fluid infusions may result in an increase in intrarenal pressure and these conditions may cause renal damage (11,19). However, a few reports evaluating long-term outcomes of SWL treatment in patients with chronic renal failure also suggest that SWL is a safe treatment modality (21,22).…”

“…In their animal model of metabolic syndrome, Handa et al (20) reported that a single session of SWL did not result in renal impairment, even in the presence of metabolic syndrome. As a result of the first study in the literature investigating the effect of RIRS on renal functions, univariate cox regression analysis revealed that multiple procedures and pre-existing chronic kidney disease were significant factors for renal deterioration (19). However, in multivariate analysis these factors did not remain as predictive factors; researchers declared that RIRS seemed to have favorable outcomes on kidney function (19).…”

“…As a result of the first study in the literature investigating the effect of RIRS on renal functions, univariate cox regression analysis revealed that multiple procedures and pre-existing chronic kidney disease were significant factors for renal deterioration (19). However, in multivariate analysis these factors did not remain as predictive factors; researchers declared that RIRS seemed to have favorable outcomes on kidney function (19). Similarly, when we evaluated the GFR changes over time with general linear model, SWL was found to be a favorable method for renal function.…”