Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases

Abstract

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.

Retrograde intrarenal surgery for management of kidney stones smaller than 20 mm: A singe center experience of 452 cases

“…Patients' demographic data are summarized in Table 1.The mean stone size was 13.5 mm (range 7-20 mm). The mean stone sizes were 13.6 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 33.8%), and multiple calyces (n=88; 19.4%). Patients' stone characteristics are summarized in Table 2.…”

“…Percutaneous nephrolithotomy has its own limitations and possible complications, including fever, sepsis, pneumothorax, colonic injury and hemorrhage requiring blood transfusion [17] . On the contrary, in many studies, it was reported that major complications were seen rare, while RIRS complications were seen as lower in Clavien degrees [17] .…”

Risk factors of stone residual after retrograde intrarenal surgery: A prospective cohort study

“…The finding that larger stone size is a risk factor for residual stones after RIRS is consistent with previous studies in the literature. 13 Doykov et al showed that larger stone size was associated with a higher incidence of stone residuals (OR = 1.12, 95% CI: 1.006-1.25). 14 Similarly, Zhu et al demonstrated that the risk of residuals increased with moderate to severe hydronephrosis, lower calyceal location, multiple and staghorn calculi, and larger stone size.…”

Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery

“…Schoenthaler et al reported SFR ranging from 54% to 96% for renal stones smaller than 2 cm after one session and 86% to 92% for renal stones larger than 2 cm after one to four sessions of RIRS [ 7 ]. Another study reported stone clearance for stone size <1.5 cm as 84%, whereas stones >1.5 cm had a clearance rate of 62% [ 18 ]. Contrary to the above study, Lin et al have found RIRS to be a safe and effective treatment option for renal stones between 2 cm and 3 cm with an acceptable SFR of 80.2% [ 19 ].…”