Does Relocation of Lower Pole Stone During Retrograde Intrarenal Surgery Improve Stone-Free Rate? A Prospective Randomized Study

Shrestha, Anil; Adhikari, Baikuntha Raj; Shah, Arvind

doi:10.1089/end.2022.0050

Cited by 6 publications

(9 citation statements)

References 29 publications

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“…The main purpose of stone treatment modalities is to achieve maximum SFR with minimum complications. Our overall complication rate was 10%, which is acceptable and comparable to published data [ 8 – 12 ]. Postoperative fever was the most common complication in our study but no urine-related sepsis or ureteral injury was observed.…”

Section: Discussionsupporting

confidence: 90%

“…Regarding operative time and total laser energy consumption, Schuster et al reported a significantly longer operative time in the relocation group [ 11 ], whereas Yaghoubian et al reported that the operative time was slightly increased in the relocation group, as well as the laser energy consumption, although with no statistical significance [ 8 ]. A similar result was achieved by Shrestha et al [ 12 ]. There was also no significant difference between the two groups in our study, due to the improved ergonomics and the popularization of flexible ureteroscopy in the last 2 decades.…”

Section: Discussionsupporting

confidence: 90%

“…Furthermore, Yaghoubian et al shared a similar experience [ 8 ]. However, another study showed that relocating LPS during RIRS did not significantly improve SFR compared to in situ lithotripsy [ 12 ]. Therefore, we performed this prospective study to assess whether relocating LPS during FURS could improve the SFR.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, several surgeons recommend relocating the LPS to a favorable calyx before lithotripsy to improve the SFR [ 1 , 8 , 11 ]. However, Shrestha et al reported relocation of LPS followed by laser lithotripsy achieved similar SFR as in situ lithotripsy [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

Huang,

Chen,

Zhou

et al. 2024

World J Urol

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Objective To compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10–20 mm lower pole stone (LPS). Methods This study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10–20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively. Results A total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up (p = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p < 0.001). Conclusion A satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

Huang,

Chen,

Zhou

et al. 2024

World J Urol

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show abstract

“…First, its retrospective nature with bias to patient enrollment. Second, stone relocation or in situ lithotripsy is not available, although the former did not demonstrate a higher SFR compared to in situ laser lithotripsy in a recent randomized study [ 28 ]. Third, pelvicalyceal anatomy was not measured using Elbahnasy’s method [ 29 ], and we could not assess its role in SFR.…”

Section: Discussionmentioning

confidence: 99%

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

Giulioni

Castellani

Somani³

et al. 2023

World J Urol

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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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Flexible ureteroscopy for lower pole calculus: is it still a challenge?

Shrestha,

Adhikari,

Panthier

et al. 2023

World J Urol

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Does Relocation of Lower Pole Stone During Retrograde Intrarenal Surgery Improve Stone-Free Rate? A Prospective Randomized Study

Cited by 6 publications

References 29 publications

Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate

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

Flexible ureteroscopy for lower pole calculus: is it still a challenge?

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