Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300mm2?

Abstract

In this study, we aim to evaluate and compare the effectiveness of flexible ureterorenoscopy (f-URS) for solitary and multiple renal stones with <300 mm2 stone burden. Patients' charts who treated with f-URS for kidney stone between January 2010 and June 2015 were reviewed, retrospectively. Patients with solitary kidney stones (n:111) were enrolled in group 1. We selected 111 patients with multiple kidney stones to serve as the control group and the patients were matched at a 1:1 ratio with respect to the patient's age, gender, body mass index and stone burden. Additionally, patients with multiple stones were divided into two groups according to the presence or abscence of lower pole stones. Stone free status was accepted as complete stone clearence and presence of residual fragments < 2 mm. According to the study design; age, stone burden, body mass index were comparable between groups. The mean operation time was longer in group 2 (p= 0.229). However, the mean fluoroscopy screening time in group 1 and in group 2 was 2.1±1.7 and 2.6±1.5 min, respectively and significantly longer in patients with multiple renal stones (P=0.043). The stone-free status was significantly higher in patients with solitary renal stones after a single session procedure (p=0.02). After third month follow up, overall success rate was 92.7% in Group 1 and 86.4% in Group 2. Our study revealed that F-URS achieved better stone free status in solitary renal stones <300 mm2. However, outcomes of F-URS were acceptable in patients with multiple stones.

Multikalisiyel ve Multiple Böbrek Taşlarının Tedavisinde Retrograd İntrarenal Cerrahi Deneyimimiz

“…RIRS is used in the treatment of multiple kidney stones. Success is lower than the single stones of the same size (7). In our study, we aimed to report our RIRS experience in the treatment of multi-caliceal and multiple kidney stones.…”

Retrograde Intra-Renal Surgery Versus Percutaneous Nephrolithotomy in Management of Renal Stone 10-20 Millimeters, A Comparative Clinical Study

“…Meanwhile, Ozgor et al 13 reported that RIRS technique resulted in lower stone-free rates in patients with multiple renal stones when (located in minimum two calyces) was reported to be 53.9% in a recent study 29 .…”

“…Another limitation is that although multicalyceal stones were operated in our study, only one access was used for PNL. However, based on previously reported high complication rates in PNL operations performed with multiple access 13,28 , we prefer single access in our department.…”

“…compared to patients with solitary renal stone even though both groups have similar stone burden (83.8% and 89.2%, respectively). When PNL is performed for multiple renal stones located in more than one calyx, more than one access may be required and it is known that multiple access may cause serious bleeding complications and loss of kidney function from previous studies 13,28 .…”

“…It is known that in cases with 10-20 stones there is a decrease in stone-free rates after procedures and that treatment of solitary stones is more effective than treatment of multiple stones with similar stone burden in RIRS 12,13 .…”