Miniaturization of PCNL; Necessity or What?

Objective: Now a days, percutaneous nephrolithotomy (PCNL) is the treatment of choice for retrieval of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study was to compare the safety and efficacy of PCNL using different tract size. Patients and Methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Mini or by Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chattogram from July 2016 to October 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, access time, fluoroscopy time for access, total operative time, need for blood transfusion, postoperative hospital stay, postoperative pain, fever, urinary leakage and other complications between two groups. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 78 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini-PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.59±0.89 cm, and 2.66±0.97 cm in standard-PCNL group (p=0.7). Mean tract size was 18.53 ± 1.29 F (16-20) and 26.11 ± 4.61 F (24-30) respectively with P value <0.001. In mini-PCNL operative time was significantly longer than that of standard PCNL with 112.11 ± 20.29 vs. 98.68± 19.75 minutes respectively with p=.004. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.26 vs. 0.83 ± 0.32 gm%, p value 0.001) and hospital stay (2.18 ± 0.77 vs. 3.39 ± 1.10 days, p value= 0.001), respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.84% vs. 92.11%, p=0.45). There was no statistical difference in terms of visual analogue scale (VAS) score (5.55±1.54 vs. 6.24±1.6) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10.52% vs 12.50%, p=0.72). No statistical difference was recorded in terms of postoperative fever (eŠ38C) between two groups (2 in each group, 5.2%, p=1 Blood transfusion requirement was much less in mini PCNL group (10.52% vs. 34.2%, p=0.01). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct tostandard PCNL, URS, and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.11-16

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Tract Size in Percutaneous Nephrolithotomy (PCNL) : Does It Really Matter?

Chattagram Maa-O-Shishu Hospital Medical College Journal ◽

10.3329/cmoshmcj.v18i2.47767 ◽

2020 ◽

Vol 18 (2) ◽

pp. 18-22

Author(s):

Mofizur Rahman ◽

Mohammed Monowar Ul Hoque ◽

Kazi Md Monwarul Karim ◽

AKM Akramul Bari ◽

Tanvir Rahman ◽

...

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Statistical Difference ◽

Pain Perception ◽

Operative Time ◽

Previous History ◽

Postoperative Fever ◽

Stone Clearance ◽

Significant Difference

Background : Percutaneous Nephrolithotomy (PCNL) is the treatment of choice in removal of renal and proximal ureteral calculi. The primary goal of PCNL is to achieve stone free status while minimizing morbidity and complications. In recent years, the instruments used have been miniaturized in an effort to decrease morbidity associated with standard PCNL as well as increase the efficacy of stone removal. The aim of this study is to compare the safety and efficacy of PCNL using different tract size. Materials and methods: This hospital based prospective interventional study was conducted on patients with 1 to 4 cm renal stones who underwent PCNL either by Minior Standard PCNL technique in Chattogram Medical College Hospital and different private hospitals in Chittagong from July 2016 to June 2018. Patients aged above 12 years of age, irrespective of gender with normal renal function were evaluated to compare stone clearance, total operative time, need for blood transfusion, postoperative pain and other complications. Those who had previous history of open renal surgery, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity were excluded. Results: A total of 64 patients were enrolled consecutively for PCNL who were divided equally into two groups randomly for minimally invasive PCNL (Mini- PCNL) and Standard PCNL. The average stone size in mini-PCNL group was 2.64 ± 0.94 cm and 2.776 ± 0.97 cm in standard-PCNL group. Mean tract size was 18.44 ± 1.32 F (16-20) and 26.7 ± 5 F (24-30) respectively. In mini-PCNL operative time was significantly longer than that of standard PCNL with 110.31 ± 21.77 vs 95.94 ± 19.82 min respectively. Conversely, there was an advantage of mini-PCNL over the standard one in terms of a significantly reduced hemoglobin drop (0.5 ± 0.25 vs. 0.8 ± 0.34) gram and hospital stay (2.13 ± 0.79 vs.3.38 ± 1.13 days) respectively though there was no statistical difference in terms of stone clearance rates between two groups (86.7% vs. 93.33%). There was no statistical difference in terms of Visual Analogue Scale (VAS) score (5.44 ± 1.5 vs.6.19 ± 1.65) for pain perception. The complication rate of mini-PCNL had no significant difference with that of standard PCNL (10% vs 13.6%). No statistical difference was recorded in terms of postoperative fever (³38oC) between two groups (2 in each group, 6.67%, p=1). Blood transfusion requirement was much less in mini PCNL group (10% vs. 33.33%). Conclusion: In addition to minimal bleeding and excellent stone clearance, mini- PCNL has several features for which it should be considered as an alternative or adjunct to standard PCNL, URS and ESWL. These include safe supra-costal puncture, excellent access to nearly all calyces and upper ureter, less hospital stay and suitable for large stones also. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of mini- PCNL. Chatt Maa Shi Hosp Med Coll J; Vol.18 (2); July 2019; Page 18-22

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Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled Trial

10.21203/rs.2.9943/v3 ◽

2020 ◽

Author(s):

Alaa Elguindy ◽

Hosam Hemeda ◽

Mohamed Esmat Shawky ◽

Mohamed Elsenity ◽

Medhat Adel Elsayed ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

P Value ◽

Intraoperative Blood Loss ◽

Postoperative Fever ◽

Longitudinal Incision ◽

Abdominal Myomectomy ◽

Randomized Controlled ◽

Uterine Incision ◽

Significant Difference

Abstract Background: It is unclear whether transverse uterine incision is non-inferior to longitudinal incision during myomectomy with regard to bleeding. Our aim was to compare between transverse and longitudinal uterine incisions in myomectomy. Methods: A parallel randomized controlled single-blinded study in a university affiliated hospital, in the period between January 2017 and April 2018, in which 52 women candidates for abdominal myomectomy were randomized into transverse uterine incision or longitudinal uterine incision groups (26 in each group). Intraoperative blood loss (estimated directly by blood volume in suction bottle and linen towels and indirectly by difference between preoperative and postoperative hematocrit), operative time and postoperative fever were analyzed. Results: No statistically significant difference was found between transverse and longitudinal incisions regarding intraoperative blood loss (389.7 ± 98.56 ml vs 485.04 ± 230.6 ml respectively, p value=0.07), operative time (59.96 ± 16.78 min vs 66.58 ± 17.33 min respectively, p value=0.18), and postoperative fever (4% vs 8.33%, p value=0.6). Conclusion: Transverse uterine incision does not cause more blood loss than longitudinal incision and is a reasonable option during abdominal myomectomy. Trial registration: NCT03009812 at clinicaltrials.gov, registered January 2017

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Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled Trial

10.21203/rs.2.9943/v4 ◽

2020 ◽

Author(s):

Alaa Elguindy ◽

Hosam Hemeda ◽

Mohamed Esmat Shawky ◽

Mohamed Elsenity ◽

Medhat Adel Elsayed ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

P Value ◽

Intraoperative Blood Loss ◽

Postoperative Fever ◽

Longitudinal Incision ◽

Abdominal Myomectomy ◽

Randomized Controlled ◽

Uterine Incision ◽

Significant Difference

Abstract Background: It is unclear whether transverse uterine incision is non-inferior to longitudinal incision during myomectomy with regard to bleeding. Our aim was to compare between transverse and longitudinal uterine incisions in myomectomy.Methods: A parallel randomized controlled single-blinded study in a university affiliated hospital, in the period between January 2017 and April 2018, in which 52 women candidates for abdominal myomectomy were randomized into transverse uterine incision or longitudinal uterine incision groups (26 in each group). Intraoperative blood loss (estimated directly by blood volume in suction bottle and linen towels and indirectly by difference between preoperative and postoperative hematocrit), operative time and postoperative fever were analyzed.Results: No statistically significant difference was found between transverse and longitudinal incisions regarding intraoperative blood loss (389.7 ± 98.56 ml vs 485.04 ± 230.6 ml respectively, p value=0.07), operative time (59.96 ± 16.78 min vs 66.58 ± 17.33 min respectively, p value=0.18), and postoperative fever (4% vs 8.33%, p value=0.6).Conclusion: Transverse uterine incision does not cause more blood loss than longitudinal incision and is a reasonable option during abdominal myomectomy.Trial registration: NCT03009812 at clinicaltrials.gov, registered January 2017

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Outcome of Single Shot versus Serial Dilatation Technique for Percutaneous Nephrolithotomy

Bangladesh Journal of Urology ◽

10.3329/bju.v23i2.50302 ◽

2020 ◽

Vol 23 (2) ◽

pp. 124-128

Author(s):

AHM Mostofa Kamal ◽

Md Shawkat Alam ◽

Md Naushad Alam ◽

Md Safiul Alam Babul ◽

Anup Roy Chowdhury ◽

...

Keyword(s):

Hospital Stay ◽

Clearance Rate ◽

Operative Time ◽

Postoperative Hospital Stay ◽

Access Time ◽

Single Shot ◽

Total Operative Time ◽

Stone Clearance ◽

Group A ◽

Group B

Background: Percutaneous nephrolithotomy (PCNL) is a common procedure for the removal of renal stones larger than 2 cm size with the advantages of lower morbidity rates, decrease in post-operative pain with faster post-operative recovery & thereby less duration of postoperative hospital stay. One of the fundamental steps of PCNL is the creation of the nephrostomy access. It can be done either by single shot dilatation or by multi-increment serial dilatation technique. Objectives: To compare the outcome of PCNL done by single versus serial dilatation technique with specific reference to renal access time, total operative time, stone clearance rate, postoperative haematuria and duration of postoperative hospital stay. Methods: It was a prospective interventional study with a sample size of sixty where odd number patients were included in group A (PCNL by single shot dilatation technique) & even number patients were in group B (PCNL by serial dilatation technique). After meticulous checking and rechecking, collected data were compiled and statistical analysis was done using computer based software SPSS (statistical package for social science, Version- 16) and Students t-test and Chi-square test were applied for hypothesis testing. ‘P’ value <0.05 was considered as significant. Results: Comparison between the two groups regarding stone size, stone clearance rate, postoperative haematuria and postoperative hospital stay were not statistically significant (p> 0.05). But mean renal access time in minutes (group A was 3.43 ± 1.14 and group B was 4.20 ± 1.37) and the mean operative time in minutes (group A was 91.13 ± 19.08 and group B was 101.67 ± 15.81) between the groups were statistically significant (p < 0.05). Conclusion: Percutaneous nephrostomy access can be successfully performed by single shot dilatation technique during PCNL with the advantages of shorter renal access time and total operative time. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.124-128

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Impact of Miniaturization on Early Outcome of Percutaneous Nephrolithotomy

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v17i3.1593 ◽

2019 ◽

Vol 17 (3) ◽

pp. 320-324

Author(s):

Mahesh Bahadur Adhikari ◽

Sumeet Karna ◽

Kinju Adhikari ◽

Atul Kasaju ◽

Jagdish Lal Baidya

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Standard Procedure ◽

Renal Stones ◽

P Value ◽

Complication Rates ◽

Significant Difference ◽

Size Standard ◽

Hemoglobin Drop

Background: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center.Methods: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 – 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy’s stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed.Results: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy’s stone score 1 and 2 in all three groups. However, majority of patients with Guy’s stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy’s stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy.Conclusions: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.Keywords: Endourology; percutaneous nephrolithotomy; PNL; urolithiasis.

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Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled Trial

10.21203/rs.2.9943/v2 ◽

2019 ◽

Author(s):

Alaa Elguindy ◽

Hosam Hemeda ◽

Mohamed Esmat Shawky ◽

Maii Nawara ◽

Mohamed Elsenity ◽

...

Keyword(s):

Blood Loss ◽

Operative Time ◽

P Value ◽

Intraoperative Blood Loss ◽

Postoperative Fever ◽

Longitudinal Incision ◽

Abdominal Myomectomy ◽

Randomized Controlled ◽

Uterine Incision ◽

Significant Difference

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Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960047119 ◽

2013 ◽

Vol 95 (7) ◽

pp. 481-485 ◽

Cited By ~ 15

Author(s):

R Birla ◽

P Patel ◽

G Aresu ◽

G Asimakopoulos

Keyword(s):

Coronary Artery ◽

Blood Transfusion ◽

Minimally Invasive ◽

Hospital Stay ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Off Pump ◽

Opcab Group ◽

Significant Difference ◽

The Mean

Introduction Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. Methods Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. Results Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). Conclusions MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.

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Do-It-Yourself Microsuture from Human Hair for Basic Microsurgical Training

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1675203 ◽

2018 ◽

Vol 35 (05) ◽

pp. 315-321

Author(s):

Pobe Luangjarmekorn ◽

Pravit Kitidumrongsook ◽

Sittisak Honsawek

Keyword(s):

Human Hair ◽

Statistical Difference ◽

Smooth Curve ◽

P Value ◽

Excellent Quality ◽

Likert Score ◽

Significant Difference ◽

Do It Yourself ◽

Knot Security

Background Microsuture is an essential material for basic microsurgical training. However, it is consumable, expensive, and sometimes unavailable in the microsurgical laboratory. To solve this problem, we developed a microsuture made from human hair and needle gauge. Methods Do-It-Yourself (DIY) microsuture is made from human hair and needle gauge 32G (BD Ultra-Fine Pen Needles 4 mm × 32G). Methods are explained step by step. This DIY microsuture (labeled as “test microsuture”) and nylon 8–0 (Ethilon suture 8–0, labeled as “standard microsuture”) were used for teaching orthopaedic residents to perform arterial anastomosis in chicken thighs. All residents practiced without knowing that “test microsuture” was made from the DIY method. After completing the training, quality of both microsutures was evaluated by questionnaire in topics of (1) thread quality (size, strength, elasticity, handing, knot perform, and knot security), (2) needle quality (size, curve, shape, sharpness, handling, and strength), (3) needle–thread interface (size, strength, and smoothness), and (4) overall quality of microsuture. Each category was evaluated by Likert score (5 = excellent, 4 = good, 3 = fair, 2 = poor, and 1 = very poor). Results The DIY microsuture was performed in three steps: (1) insert human hair into needle gauge by microforceps, (2) bend needle into smooth curve, and (3) disconnect needle and create needle–hair interface. The questionnaire was completed by 30 orthopaedic residents and showed that thread quality of DIY and standard microsuture had “good” and “good-to-excellent” quality (mean Likert score: 3.77–4.23 and 3.80–4.27, respectively, with no statistical difference). Thread–needle interface quality of DIY and standard microsuture also had “good” and “good-to-excellent” quality (Likert score: 3.73–4.20 and 4.07–4.33, respectively, with no statistical difference). Needle part of DIY microsuture had lower quality than standard suture (fair-to-good compared with good-to-excellence quality, score 3.30–3.67 vs. 4.20–4.27, respectively, with a statistically significant difference, p-value < 0.05). However, overall quality of DIY suture and standard microsuture had “good” and “good-to-excellent” (mean Likert score: 3.73 and 4.00, respectively, with no statistical difference). Conclusion The DIY microsuture from human hair and needle gauge could be an alternative for basic microsurgical training with lower cost, easy production, and more availability for use in practice with acceptable quality compared with that of standard microsuture.

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Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i30b31641 ◽

2021 ◽

pp. 65-69

Author(s):

Shiraz Shaikh ◽

Champa Sushel ◽

Ahsan Ali Laghari ◽

Qamber Ali Laghari ◽

Zameer Hussain Laghari ◽

...

Keyword(s):

Hospital Stay ◽

Total Thyroidectomy ◽

Calcium Level ◽

Operative Time ◽

Nodular Goiter ◽

Cross Sectional Study ◽

Cross Sectional ◽

Post Operative Pain ◽

Significant Difference ◽

One Year

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage. Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain & post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20. Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-<0.001). Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

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Retrograde Intrarenal surgery- Our experience

Academia Journal of Surgery ◽

10.47008/ajs/2020.3.1.19 ◽

2020 ◽

Vol 3 (1) ◽

pp. 88-92

Author(s):

Nand Kumar B. Madhekar ◽

A. Nischal Prasad

Keyword(s):

Hospital Stay ◽

Operative Time ◽

Tertiary Care ◽

Renal Stones ◽

Tertiary Care Centre ◽

Renal Surgery ◽

Retrograde Intrarenal Surgery ◽

Residual Stone ◽

Stone Clearance ◽

Residual Stones

Background: RIRS has become an important treatment option for kidney stones in pediatric patients with the development of new-generation ureteroscopy and holmium laser. The present study was conducted to assess cases of retrograde intrarenal surgery. Subjects and Methods: The present study was conducted in a tertiary care centre over a period of one year on 120 cases of retrograde intra renal surgery (RIRS) performed in both genders. Renal stone location and stone clearance, laterality, stone size, operative time, hematuria, postoperative pain & fever, urosepsis, hospital stay, residual stones and need of an adjunctive procedure to achieve residual stone clearance. Results: Out of 120 patients, males were 70 and females were 50. Stones were detected in upper calyx in 50 cases, middle calyx in 40, lower calyx in 20 and pelvis in 10 cases. The mean size of stones was 8.1 mm, operative time was 62.1 minutes, hospital stay was 3.6 days, clinically insignificant radiological fragments were seen in 35 cases and residual stones were seen in 20 cases. Maximum cases of CIRF were seen in middle calyx (15) and residual stones were seen in lower calyx (7). The difference was significant (P< 0.05). Common complications were fever in 7, hematuria in 3, flank pain in 4 and urosepsis in 2 cases. Conclusion: Authors found that retrograde intrarenal surgery is a technically safe and effective procedure for the treatment of renal stones.

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