scholarly journals Outcomes of fluoroscopy-free retrograde intrarenal surgery and predictive factors of stone-free

2021 ◽  
Vol 93 (4) ◽  
pp. 425-430
Author(s):  
Huseyin Kocakgol ◽  
Hasan Riza Aydin ◽  
Ahmet Ozgur Guctas ◽  
Cagri Akin Sekerci ◽  
Deniz Ozturk Kocakgol ◽  
...  
Keyword(s):  
Operation Time ◽  
Female Gender ◽  
Ureteral Injury ◽  
Preoperative Imaging ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Stone Burden ◽  
Stone Free Rate ◽  
Stone Density ◽  
Free Rate

Objective: To evaluate the outcomes of flouroscopy-free retrograde intrarenal surgery (ffRIRS) and to investigate the factors that may affect stone-free rate. Materials and methods: The charts of patients who underwent ffRIRS between January 2017 and August 2019 were reviewed retrospectively. Patients with missing preoperative imaging and patients with kidney anomalies were excluded from the study. Age, gender, stone size, stone localization, stone density, laterality, operation time, stone-free rate, complications and auxiliary procedures were recorded and analyzed. Results: Study group involved 44 (43.1%) female and 58 (56.8%) male patients. Stone-free rate in a single-session ffRIRS were found to be correlated with stone localization (p = 0.003), stone volume (p = 0.004), and stone density (p = 0.009) but not with age (p = 0.950). Patients with multiple calyceal stones and a stone burden over 520 mm3 were found to be less stone-free. The complication rate in female gender (n = 7) was significantly higher compared to male (n = 1) (p = 0.011). No major complications such as ureteral injury or avulsion were observed. Overall, 13 patients (12.7%) needed auxiliary procedures. The operation time seemed to be affected by stone size and gender (p = 0.005; p = 0.044, respectively). Conclusions: Stone-free rate in ffRIRS were found to be affected by stone density, size, and localization. Patients with multiple caliceal stones and high stone burden (< 520 mm3) have been found to have low stone-free rate, so one can speculate that having fluoroscopy assistance in RIRS might help us to improve surgical success.

scholarly journals External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cong Wang ◽  
ShouTong Wang ◽  
Xuemei Wang ◽  
Jun Lu
Keyword(s):  
Scoring System ◽  
Kidney Stone ◽  
Medical Center ◽  
External Validation ◽  
Retrograde Intrarenal Surgery ◽  
Stone Burden ◽  
Stone Free Rate ◽  
Stone Density ◽  
Free Rate ◽  
Free Status

Abstract Background The R.I.R.S. scoring system is defined as a novel and straightforward scoring system that uses the main parameters (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) to identify most appropriate patients for retrograde intrarenal surgery (RIRS). We strived to evaluate the accuracy of the R.I.R.S. scoring system in predicting the stone-free rate (SFR) after RIRS. Methods In our medical center, we retrospectively analyzed charts of patients who had, between September 2018 and December 2019, been treated by RIRS for kidney stones. A total of 147 patients were enrolled in the study. Parameters were measured for each of the four specified variables. Results Stone-free status was achieved in 105 patients (71.43%), and 42 patients had one or more residual fragments (28.57%). Differences in stone characteristics, including renal infundibulopelvic angle, renal infundibular length, lower pole stone, kidney stone density, and stone burden were statistically significant in patients whether RIRS achieved stone-free status or not (P < 0.001, P: 0.005, P < 0.001, P < 0.001, P: 0.003, respectively). R.I.R.S. scores were significantly lower in patients treated successfully with RIRS than patients in which RIRS failed (P < 0.001). Binary logistic regression analyses revealed that R.I.R.S. scores were independent factors affecting RIRS success (P = 0.033). The area under the curve of the R.I.R.S. scoring system was 0.737. Conclusions Our study retrospectively validates that the R.I.R.S. scoring system is associated with SFR after RIRS in the treatment of renal stones, and can predict accurately.

Comparison of laparoscopic pyelolithotomy and retrograde intrarenal surgery in the management of large renal pelvic stone

2020 ◽  
Author(s):  
Mehmet Cagatay Cicek ◽  
Tariq Asi ◽  
Kadir Omur Gunseren ◽  
Hakan Kilicarslan
Keyword(s):  
Operation Time ◽  
Retrograde Intrarenal Surgery ◽  
Median Hospital Stay ◽  
Efficient Procedure ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Median Hospital ◽  
Free Rate

Abstract Background To compare the clinical outcomes of laparoscopic pyelolithotomy (LP) and retrograde intrarenal surgery (RIRS) in the management of large renal pelvic stones. Methods This study included patients who presented with a single renal pelvic stone sized ≥20 mm and who were treated primarily by laparoscopic pyelolithotomy or retrograde intrarenal surgery. The patients were grouped based on the surgical procedure they underwent. We retrospectively examined and compared the age, the longest axis and the surface area of the stone, operation time, hospitalization time, complications and stone-free rates of the two groups. Results Of the 156 patients included in the study, 44 had laparoscopic pyelolithotomy, and 112 had retrograde intrarenal surgery. Patients who received laparoscopic pyelolithotomy (13 males, 31 females) had a median age of 54 (18-79) years, while those who underwent retrograde intrarenal surgery (46 males, 66 females) had a median age of 54.5 (18-79). Patients who received laparoscopic pyelolithotomy were found to have larger median stone size (30 mm vs 24 mm, p=0.003), longer operation time (100 minutes vs 70 minutes, p=0.007), lower complication rate (2% vs 8.9%, p=0.063), longer median hospital stay (3 days vs 1 day, p<0.001) and better stone-free rate at the third month (90.9% vs 67.9%, p<0.001). Conclusion LP is a safe and efficient procedure that could be used as an alternative to retrograde intrarenal surgery in managing large renal pelvic stones.

scholarly journals The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Wonho Jung ◽  
Hye Jin Byun ◽  
Dong Sup Lee
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Operation Time ◽  
Percutaneous Nephrostomy ◽  
Stone Size ◽  
Stone Free Rate ◽  
Ureter Stones ◽  
Free Rate

Objective. We aimed to investigate the role of antegrade irrigation via percutaneous nephrostomy on surgical outcomes in retrograde ureteroscopy in patients with upper ureter stones. Materials and Methods. In this retrospective study, we analyzed 134 patients who underwent retrograde semirigid ureteroscopy for upper ureter stones between August 2012 and December 2017. Patients were divided into two groups: retrograde irrigation group (conventional URS) and antegrade irrigation group (using percutaneous nephrostomy). Operation time, postoperative hospital stay, complications, and stone-free rate were measured for each patient after ureteroscopy. Results. The mean age in the retrograde irrigation and antegrade irrigation groups was 53.3 and 60.7 years, respectively (p=0.007). The operation time was 60.8 min vs. 43.0 min (p=0.002), and stone-free rate was 82.0 % vs. 95.5 % (p=0.033). Stone size, laterality, the proportion of male patients, and urinary tract infection prevalence were comparable between the groups. In the subgroup analysis of stone size >10 mm, the antegrade irrigation group had a shorter operation time and a higher stone-free rate. For stone size of 5–10 mm, operation time in the antegrade irrigation group was shorter and the stone-free rate between the two groups was comparable. Conclusion. Antegrade irrigation via percutaneous nephrostomy during ureteroscopy has a higher stone-free rate with a shorter operation time without an increased urinary tract infection risk. Therefore, if percutaneous nephrostomy is necessary before ureteroscopy, antegrade irrigation of external fluid via percutaneous nephrostomy is strongly recommended.

Percutaneous-Based Management of Staghorn Calculi in Solitary Kidney: Combined Mini Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery

2014 ◽  
Vol 94 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Wen Zhong ◽  
Zhijian Zhao ◽  
Liang Wang ◽  
Sunil Swami ◽  
Guohua Zeng
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Operation Time ◽  
Solitary Kidney ◽  
Retrograde Intrarenal Surgery ◽  
Staghorn Calculi ◽  
Combined Use ◽  
Stone Free Rate ◽  
Group 2 ◽  
Free Rate ◽  
Group 1

Introduction: Mini percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are well-established techniques with little morbidity. The combined use of standard PCNL and the mini-PCNL or the RIRS technique was evaluated and compared to investigate their own role in the management of staghorn calculi in solitary kidney. Materials and Methods: 23 patients received combined standard PCNL and mini-PCNL (group 1), and 22 patients received combined standard PCNL and RIRS (group 2). The treatment results and complications were evaluated and compared. Results: The mean operation time was 128.8 ± 9.1 min in group 1 and 109.8 ± 10.7 min in group 2 (p < 0.001). The decrease in hemoglobin level in group 1 was significantly higher than that in group 2 (3.5 ± 0.6 vs. 2.1 ± 0.5 g/dl, p < 0.001). The final stone-free rate was significantly higher (p = 0.038) in group 2 (90.9%) than in group 1 (65.2%). Conclusions: Combined standard PCNL and RIRS technique can extract the majority of staghorn calculi quickly by PCNL with EMS Lithoclast, and RIRS used simultaneously can reduce the need for multiple tracts and therefore reduce blood loss and potential morbidity related to multiple tracts, shorten the operation time and achieve a high stone-free rate.

scholarly journals Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases

2021 ◽  
Vol 93 (3) ◽  
pp. 313-317
Author(s):  
Orazio Maugeri ◽  
Ettore Dalmasso ◽  
Dario Peretti ◽  
Fabio Venzano ◽  
Germano Chiapello ◽  
...  
Keyword(s):  
Laser Lithotripsy ◽  
Urinary Stones ◽  
Flexible Ureteroscopy ◽  
Safe Procedure ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Clinical Complications ◽  
Holmium Laser Lithotripsy ◽  
Stone Free Rate ◽  
Free Rate

Introduction: The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). Materials and methods: A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. Results: The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). Conclusions: The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.

scholarly journals Split-leg percutaneous nephrolithotomy: A safe and versatile technique

2013 ◽  
Vol 85 (2) ◽  
pp. 82 ◽  
Author(s):  
Eugenio Di Grazia ◽  
Pasquale La Rosa
Keyword(s):  
Ct Scan ◽  
Urinary Stones ◽  
Flexible Ureteroscopy ◽  
Surgical Time ◽  
Retrograde Intrarenal Surgery ◽  
Stone Size ◽  
Stone Free Rate ◽  
Versatile Technique ◽  
Hemoglobin Drop ◽  
Free Rate

Objectives: Percutaneos nephrolithotomy (PCNL) is the gold standard for treatment of urinary stones larger than 2 cm and refractory to ESWL. Nowadays most debate about surgical technique is related to the positioning of patients. We report our expe- rience on prone PCNL with split-leg variant (SL-PCNL) Materials and methods: 30 consecutive patients underwent prone SL-PCNL. Preoperative stone size was deter- mined by measuring stones longest diameter on CT scan. In cases with multiple stones, stone size was determined by the sum of each stone diameter on CT scan. Patients evaluated con- sisted of 20 females and 10 males and median age was 55 (20-72). The average BMI was 27 (24-35). 15 patients had multiple stones, 10 pyelocalicial, 10 pelvic larger than 2 cm, 2 in horseshoe kidneys and 3 staghorn stones. Results: Stone free rate was 87% after first look and 97% after second look. In 2 cases, we used a flexible ureteroscopy 7.5 Fr (Flex 2 - Storz) to treat a calculus in ureter or for a contemporary double access (Endoscopic combined Retrograde Intrarenal Surgery ECIRS). In 28 cases we placed a 20 fr nephrostomy while in two cases procedure was tubeless. In 20 cases we placed a double-J catheter. In 2 cases we performed two tract and in 2 horseshoe kidneys access was close to spine. The average surgical time was about 90 minutes (range 30-120 minutes). Hemoglobin drop was about 1.5 mg/dl (range 1-3 .4 mg/dl) and no major complications were reported. Conclusions: In our experience PCNL in prone with spread-legs variant is a versatile technique and allows to match the advantages you have with same technique in supine, providing at the same time benefits in cases of anatomical abnormalities, challenging cases, or when multi-tract accesses are required.

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

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.

scholarly journals Factors Impacting Stone-Free Rate After Retrograde Intrarenal Surgery for Calyceal Diverticular Calculi

2020 ◽  
Vol Volume 12 ◽  
pp. 345-350
Author(s):  
Chatporn Boonyapalanant ◽  
Pat Saksirisampant ◽  
Tawatchai Taweemonkongsap ◽  
Sunai Leewansangtong ◽  
Sittiporn Srinualnad ◽  
...  
Keyword(s):  
Retrograde Intrarenal Surgery ◽  
Stone Free Rate ◽  
Free Rate

scholarly journals Comparison of ultrasound-assisted and pure fluoroscopy-guided extracorporeal shockwave lithotripsy for renal stones

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tsung-Hsin Chang ◽  
Wun-Rong Lin ◽  
Wei-Kung Tsai ◽  
Pai-Kai Chiang ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Shock Wave ◽  
Renal Stones ◽  
Disintegration Rate ◽  
Stone Size ◽  
Stone Free Rate ◽  
The Usa ◽  
Retreatment Rate ◽  
Ultrasound Assisted ◽  
Localization And Tracking ◽  
Free Rate

Abstract Background In this study, we aimed to compare the efficacy and clinical outcomes of shock wave lithotripsy (SWL) for patients with renal stones using pure fluoroscopy (FS) or ultrasound-assisted (USa) localization with two lithotripters. Methods We retrospectively identified 425 patients with renal calculi who underwent SWL with either a LiteMed LM-9200 ELMA lithotripter (209 cases), which combined ultrasound and fluoroscopic stone targeting or a Medispec EM-1000 lithotripter machine (216 cases), which used fluoroscopy for stone localization and tracking. The patient demographic data, stone-free rates, stone disintegration rates, retreatment rates and complication rates were analyzed. Results The USa group had a significantly higher overall stone-free rate (43.6 vs. 28.2%, p < 0.001) and stone disintegration rate (85.6 vs. 64.3%, p < 0.001), as well as a significantly lower retreatment rate (14.8 vs. 35.6%, p < 0.001) and complication rate (1.9 vs. 5.5%, p = 0.031) compared with the FS group. This superiority remained significant in the stone size < 1 cm stratified group. In the stone size > 1 cm group, the stone-free rate (32.4 vs. 17.8%, p = 0.028), disintegration rate (89.2 vs. 54.8%, p = 0.031) and retreatment rate (21.6 vs. 53.4%, p < 0.001) were still significantly better in the USa group, however there was no significant difference in the complication rate. The most common complication was post-SWL-related flank pain. Conclusion SWL is a safe and non-invasive way of treating renal stones. This study compared two electromagnetic shock wave machines with different stone tracking systems. LiteMed LM-9200 ELMA lithotripter, which combined ultrasound and fluoroscopic stone targeting outperformed Medispec EM-1000 lithotripter, which used fluoroscopy for stone localization and tracking, with better stone-free rates and disintegration rates, as well as lower retreatment rates and complications with possible reduced radiation exposure.

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