The effect of preoperative ureteral stenting in retrograde Intrarenal surgery: a multicenter, propensity score-matched study

Abstract Background Stent placement before retrograde intrarenal surgery (RIRS) can theoretically expand the ureter to improve access and remove stones. The purpose of this study was to investigate the effect of preoperative ureteral stenting on access and surgery. Methods We retrospectively analyzed patients who underwent RIRS between January 2010 and December 2016 at multiple centers. The patients were divided into two groups based on whether or not a ureteral stent was inserted preoperatively. The characteristics of the stone (size, number, density, and location), the success rate of the access sheath placement, perioperative complications, operative times, hospitalization periods, the period for which the stents remained, postoperative urinary tract infection rates, stone-free rates, and additional treatment rates were analyzed. Results Overall, 727 patients were included in the study (113 were pre-stented and 614 were non-stented). The median stone size was 12.2 mm. The overall stone-free rate (SFR) was 85.8% for the pre-stented group and 83.2% for the non-stented group, showing no significant (p = 0.498) difference between the two groups. Preoperative ureteral stenting improved the success rate of sheath placement (93.8% vs. 85.3%, p = 0.023) during surgery. The access sheath size in participants in the pre-stented group showed a tendency to be larger than that in participants in the non-stented group. However, there were no differences in perioperative complications, operative times, additional treatment rates, and stone-free rates. Conclusions Although preoperative ureteral stenting did not affect operative outcomes, it increased the success rate of access sheath placement. Depending on the patient’s characteristics, preoperative ureteral stenting can be considered as an adjunctive option when access sheath insertion is considered during RIRS.

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A presumptive role of lower ureteral angles in the difficulty of ureteral access sheath insertion during retrograde intrarenal surgery

International Urology and Nephrology ◽

10.1007/s11255-020-02483-1 ◽

2020 ◽

Vol 52 (9) ◽

pp. 1657-1663

Author(s):

Sung Yong Cho ◽

Seung Hoon Ryang ◽

Dong Sup Lee

Keyword(s):

Retrograde Intrarenal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Sheath Insertion

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PD34-09 PREOPERATIVE TAMSULOSIN IN INCREASING THE PROBABILITY OF URETERAL ACCESS SHEATH INSERTION DURING RETROGRADE INTRARENAL SURGERY

The Journal of Urology ◽

10.1097/ju.0000000000000905.09 ◽

2020 ◽

Vol 203 ◽

pp. e714

Author(s):

Pawan Dhital* ◽

Diwas Gnyawali ◽

Uttam Sharma ◽

Bhojraj Luitel

Keyword(s):

Retrograde Intrarenal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Sheath Insertion

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The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled Study

The Journal of Urology ◽

10.1016/j.juro.2017.09.173 ◽

2018 ◽

Vol 199 (6) ◽

pp. 1622-1630 ◽

Cited By ~ 12

Author(s):

Kyo Chul Koo ◽

Jun-Ho Yoon ◽

No-Cheol Park ◽

Hye Sun Lee ◽

Hyun Kyu Ahn ◽

...

Keyword(s):

Mucosal Injury ◽

Controlled Study ◽

Insertion Force ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Randomized Controlled ◽

Upper Limit ◽

Adrenergic Antagonists ◽

Sheath Insertion ◽

The Impact

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Is stenting required before retrograde intrarenal surgery with access sheath

Indian Journal of Urology ◽

10.4103/0970-1591.56185 ◽

2009 ◽

Vol 25 (3) ◽

pp. 326 ◽

Cited By ~ 9

Author(s):

SS Bapat ◽

PM Mahajan ◽

AS Padhye ◽

AA Bhave ◽

YB Sovani ◽

...

Keyword(s):

Retrograde Intrarenal Surgery ◽

Access Sheath

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Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.3.318 ◽

2021 ◽

Vol 93 (3) ◽

pp. 318-322

Author(s):

Bulent Kati ◽

Eyyup Sabri Pelit ◽

Mehmet Demir ◽

Ismail Yagmur ◽

Adem Tuncekin ◽

...

Keyword(s):

Kidney Stone ◽

Surgical Complication ◽

Operation Time ◽

Patient Characteristics ◽

Solitary Kidney ◽

Retrograde Intrarenal Surgery ◽

Stone Size ◽

Operation Duration ◽

The Mean ◽

Duration Of Operation

Objective: The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Methods: Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. Results: A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Conclusion: Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

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Pre-stenting for Retrograde Intrarenal Surgery: Need and Duration: a Prospective Randomized Clinical Study

Nepalese Medical Journal ◽

10.3126/nmj.v3i2.33050 ◽

2020 ◽

Vol 3 (2) ◽

pp. 361-365

Author(s):

Prakash Chhettri ◽

Anil Shrestha ◽

Robin Bahadur Basnet ◽

Parash Mani Shrestha

Keyword(s):

Controlled Study ◽

Retrograde Intrarenal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Randomized Clinical Study ◽

Institutional Review ◽

Group 3 ◽

Group 2 ◽

Wall Injury ◽

Group 1

Introduction: To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. In case pre-stenting becomes an option, how long does it need to be stented. Materials and Methods: After obtaining approval from Institutional Review Board and informed consent, a prospective randomized controlled study was conducted in the Department of Urology, Bir Hospital for 18 months. All the patients enrolled for retrograde intrarenal surgery were grouped into 3 groups: Group 1 – without pre-stenting, Group 2 – one week of pre-stenting, and Group 3 – two weeks of pre-stenting. Success was defi ned as an ability to accommodate a 10/12 F ureteral access sheath during retrograde intrarenal surgery. Ureteral access sheath induced ureteric wall injury was also taken into consideration.Results: Among 179 cases, 152 cases were included in the study. In 36 patients out of 53 (67.92%) in group 1, 10/12 F ureteral access sheath was negotiable without pre-stenting, marking the frequency of distensible ureters. In 44 patients out of 47 (93.66%) from group 2 and all 52 patients (100%) from group 3, ureteral access sheath placement was successful after one and two weeks of pre-stenting respectively. Ureteric wall injury of grade1 and 2, was found in 9 patients (5.9%).Conclusions: The majority of ureters (67.92%) are distensible, not requiring pre-stenting before retrograde intrarenal surgery. One and two weeks of pre-stenting carries a success rate of 93.66% and 100% respectively.

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Laparoscopic pyelolithotomy: its current place in the management of renal pelvis stones

International Surgery Journal ◽

10.18203/2349-2902.isj20203240 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2598

Author(s):

Dinesh Prasad ◽

Shivamshekhar Singh

Keyword(s):

Success Rate ◽

Renal Pelvis ◽

Therapeutic Option ◽

Perioperative Complications ◽

Tertiary Care ◽

Alternative Therapy ◽

Renal Parenchyma ◽

Ct Urography ◽

Tertiary Care Centre ◽

Laparoscopic Pyelolithotomy

Background: Laparoscopic pyelolithotomy is assumed to preserve functional renal parenchyma, and there is a limited risk for immediate or late renal hemorrhage. Therefore, it might be an alternative for the patients in whom maximal preservation of renal parenchyma is necessary. In the present study, we aimed to compare the success rate and perioperative complications of laparoscopic pyelolithotomy. In the present study, we aimed to document and compare the success rate and perioperative complications of laparoscopic pyelolithotomy with published literature about percutaneous nephrolithotomy (PCNL).Methods: We retrospectively reviewed the clinical charts of all patients subjected to laparoscopic pyelolithotomy (18 cases) in the Department of General Surgery at SMIMER Hospital (tertiary care centre), Surat between the period of January 2014 to December 2018. Record of all patients were assessed for demographic profile, co morbidities, routine blood investigations, including RFT, urine cytology and culture sensitivity, specialized investigation as X-ray KUB, USG KUB, IVP/CT-Urography, DTPA scan, all patients were called for follow up evaluation with radiological, clinical and RFT studies at regular intervals upto 3 months.Results: LP is considered a successful alternative therapy for PCNL in selected cases with large renal stones like those in the extra renal pelvis in patients without a history of previous surgery. In addition, laparoscopic pyelolithotomy (LP) can be considered as a reasonable therapeutic option for large staghorn calculus which cannot be removed with a reasonable number of access and sessions of PCNL.Conclusions: Our results show that laparoscopic pyelolithotomy is equally good or better as compared to PCNL in selected cases.

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Variation of Fluoroscopic Radiation Dose during Endourological Procedures for Renal Stones

Nepalese Medical Journal ◽

10.3126/nmj.v3i1.29370 ◽

2020 ◽

Vol 3 (1) ◽

pp. 272-275

Author(s):

Prakash Chhettri ◽

Robin Bahadur Basnet ◽

Anil Shrestha ◽

Parash Mani Shrestha

Keyword(s):

Radiation Dose ◽

Percutaneous Nephrolithotomy ◽

Prospective Observational Study ◽

Renal Stones ◽

Retrograde Intrarenal Surgery ◽

Stone Size ◽

Ureteral Access Sheath ◽

Pelvicalyceal System ◽

Ureteric Catheter ◽

Fluoroscopic Time

Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Introduction: Fluoroscopic guidance is routine for endourological procedures like percutaneous nephrolithotomy and retrograde intrarenal surgery in vast majority of centers. It is used for the initial retrograde ureteral access to define the pelvicalyceal system, puncture of the desired calyx and dilatation of the tract, aid navigation of stones and calyces, and placement of guide wires and stents. Both the patient and operating staffs are exposed to the radiation during surgery. The purpose of this study is to measure that exposed fluoroscopic radiation dose during these procedures and make operating surgeons aware of their fluoroscopic habit. Materials and Methods: This is prospective observational study, who underwent percutaneous nephrolithotomy (n=60) and retrograde intrarenal surgery (n=43) in our institute between December 2017 and August 2018. Percutaneous nephrolithotomy was done in prone position with prior insertion of ureteric catheter. Retrograde intrarenal surgery was carried out with or without insertion of ureteral access sheath. Fluoroscopic time was taken from the insertion of the ureteric catheter or UAS to the completion of the procedure with double J stenting. Results: For percutaneous nephrolithotomy and retrograde intrarenal surgery group, mean stone size were 21.89 mm and 10.56 mm; mean fluoroscopic time were 117.95 s (range 24-350) and 31.83 s (range 3-103); mean fluoroscopic dose were 29.71 mGy and 6.19 mGy respectively. Conclusions: Among the endourological procedures for renal stones, retrograde intrarenal surgery was associated with less fluoroscopic hazard than percutaneous nephrolithotomy. Awareness of fluoroscopic exposure duration and experience of a surgeon can minimize the radiation hazard during endourological procedures.

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Risk factors of infectious complications after retrograde intrarenal surgery: a retrospective clinical analysis

Journal of International Medical Research ◽

10.1177/0300060520956833 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052095683

Author(s):

Hua Zhang ◽

Tao Jiang ◽

Rui Gao ◽

Qin Chen ◽

Weiwen Chen ◽

...

Keyword(s):

Risk Factors ◽

Operative Time ◽

Small Diameter ◽

Modern Society ◽

Clinical Analysis ◽

Infectious Complications ◽

Stone Disease ◽

Lithotomy Position ◽

Retrograde Intrarenal Surgery ◽

Stone Size

Objective Stone disease is one of the most common afflictions in modern society. Complications following retrograde intrarenal surgery (RIRS) vary considerably, and small-diameter ureteral access sheaths are reportedly significantly associated with rates of infectious complications following RIRS. This study aimed to explore additional risk factors for infectious complications after RIRS. Methods This study retrospectively analyzed 602 patients who underwent RIRS between December 2016 and October 2019 at the First Affiliated Hospital of Fujian Medical University. All flexible ureteroscopic lithotripsy processes were conducted with patients under general anesthesia in the low lithotomy position. Postoperative systemic inflammatory response syndrome (SIRS) was diagnosed; statistical analyses comprised two-way analysis of variance (ANOVA) and one-way multivariate ANOVA. Results The incidence of infectious complications after RIRS was 7.14%. Operative time was an independent risk factor that increased the risk of infection. Stone size >2 cm was observed in 153 (27.37%) patients in the SIRS group and 29 patients (67.44%) in the non-SIRS group. Conclusions Findings in the literature suggest that early antibiotic treatment and active fluid therapy might lower the rate of infectious complications after RIRS. Our results indicate that extended operative time and increased stone size may be risk factors for infectious complications after RIRS.

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