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

Abstract

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.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

“…RIRS gained prominence in the management of renal stones and is currently recommended for kidney stones measuring up to 2 cm in the largest diameter ( 9 ). In current practice, RIRS is regarded as an outpatient procedure due to its safety ( 10 , 11 ). The advancement of technology and instruments employed has also heightened the effectiveness of this surgical procedure.…”

Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR)

“…In a meta-analysis of randomized control trials, both mini-PCNL and standard PCNL demonstrated higher SFR, at 86%, compared to RIRS which had an SFR of 79%. However, the overall rate of complications was significantly lower following RIRS (11%), as opposed to standard (32%) and mini-PCNL (16%) [ 35 ]. Therefore, RIRS emerges as the safest approach, offering an acceptable SFR.…”

Der 1 cm UKG-Stein: ESWL, URS oder Mini-PCNL? Leitlinien versus Realität

“…Die Kosten-Nutzen-Analysen und die Preisentwicklung sowohl im Single-use-als auch im Reusable-Segment darf man mit Interesse beobachten. Einen aktuellen Überblick über Möglichkeiten und Grenzen der Behandlung von Unterpolsteinen mittels RIRS gibt die 2023 publizierte, multinational-multizentrische Fallsammlung von fast 3000 Patienten des Flexible Ureteroscopy Outcomes Registry (FLEXOR) [10]. Die Patienten waren im Mittel ca.…”