Outcomes of Retrograde Intrarenal Surgery in Renal Calculi of Varying Size

Overview

Journal Indian J Urol

Specialty Urology

Date 2022 Apr 11

PMID 35400866

Authors

Vigneswara Srinivasan Sockkalingam Venkatachalapathy

Datson George Palathullil

Dempsey Mohan Sam

Abhishek Prasad

George Palathullil Abraham

Affiliations

Soon will be listed here.

Abstract

Introduction: Technological advancements have made it possible to attempt retrograde intrarenal surgery (RIRS) in patients with large renal calculi. The objective of this study was to compare the intraoperative adverse events, postoperative complications and stone free rates (SFR) of RIRS in patients with renal calculi of varying sizes.

Methods: Patients who underwent RIRS for renal calculi between January 2016 and June 2020 were categorized into six size groups according to the longest dimension or cumulative measurement of the longest dimension of calculi as follows: Group 1 (1-9 mm), Group 2 (10-19 mm), Group 3 (20-29 mm), Group 4 (30-39 mm), Group 5 (40-49 mm) and Group 6 (≥50 mm). All the patients were followed up for a period of 6 months post treatment completion and the outcomes of interest were computed and compared.

Results: Two hundred and ten patients were included in the analysis. Intraoperative adverse events were noted in 9.5%, 8%, 16.9%, 9.1%, 6.7% and 28.6% of the patients in groups 1-6, respectively ( = 0.453). The postoperative complications were noted in 4.8%, 5.3%, 6.8%, 15.2%, 26.7% and 42.9% of patients in groups 1-6, respectively ( = 0.024). The final SFRs were 95.2%, 100%, 96.6%, 90.9%, 86.7% and 71.4% in groups 1-6, respectively ( = 0.012).

Conclusions: RIRS is an effective treatment option for the management of renal stones, including those larger than 20 mm in size. We noted a size dependent increase in the postoperative complications and a reduction in the SFRs. The majority of the postoperative complications were low grade and no stone related events occurred in the patients who were managed conservatively for residual stones after surgery, on the short term follow up.

Citing Articles

The efficacy of flexible ureteroscopy for large volume stones and hazards of ureteral access sheath usage: A prospective randomized study.

Rammah A, Khaled F, Zamel S, Elkady A, Morsy S, Abdelwahab M Arab J Urol. 2025; 23(1):62-69.

PMID: 39776554 PMC: 11703511. DOI: 10.1080/20905998.2024.2398378.

References

Alenezi H, Denstedt J . Flexible ureteroscopy: Technological advancements, current indications and outcomes in the treatment of urolithiasis. Asian J Urol. 2017; 2(3):133-141. PMC: 5730717. DOI: 10.1016/j.ajur.2015.06.002. View

Akilov F, Giyasov S, Mukhtarov S, Nasirov F, Alidjanov J . Applicability of the Clavien-Dindo grading system for assessing the postoperative complications of endoscopic surgery for nephrolithiasis: a critical review. Turk J Urol. 2015; 39(3):153-60. PMC: 4548625. DOI: 10.5152/tud.2013.032. View

Goldberg H, Golomb D, Shtabholtz Y, Tapiero S, Creiderman G, Shariv A . The "old" 15 mm renal stone size limit for RIRS remains a clinically significant threshold size. World J Urol. 2017; 35(12):1947-1954. DOI: 10.1007/s00345-017-2075-8. View

Xu Y, Min Z, Wan S, Nie H, Duan G . Complications of retrograde intrarenal surgery classified by the modified Clavien grading system. Urolithiasis. 2017; 46(2):197-202. DOI: 10.1007/s00240-017-0961-6. View

Karim S, Hanna L, Geraghty R, Somani B . Role of pelvicalyceal anatomy in the outcomes of retrograde intrarenal surgery (RIRS) for lower pole stones: outcomes with a systematic review of literature. Urolithiasis. 2019; 48(3):263-270. PMC: 7220875. DOI: 10.1007/s00240-019-01150-0. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Somani B, Desai M, Traxer O, Lahme S . Stone-free rate (SFR): a new proposal for defining levels of SFR. Urolithiasis. 2013; 42(2):95. DOI: 10.1007/s00240-013-0630-3. View

Berardinelli F, DE Francesco P, Marchioni M, Cera N, Proietti S, Hennessey D . Infective complications after retrograde intrarenal surgery: a new standardized classification system. Int Urol Nephrol. 2016; 48(11):1757-1762. DOI: 10.1007/s11255-016-1373-1. View

Pietropaolo A, Jones P, Whitehurst L, Somani B . Role of 'dusting and pop-dusting' using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months. Urolithiasis. 2018; 47(4):391-394. PMC: 6647176. DOI: 10.1007/s00240-018-1076-4. View

10.

Kim H, Gerber G . Use of ureteroscopy and holmium:yttrium-aluminum-garnet laser in the treatment of an infundibular stenosis. Urology. 2000; 55(1):129-31. DOI: 10.1016/s0090-4295(99)00385-4. View

11.

Kronenberg P, Somani B . Advances in Lasers for the Treatment of Stones-a Systematic Review. Curr Urol Rep. 2018; 19(6):45. PMC: 5958148. DOI: 10.1007/s11934-018-0807-y. View

12.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

13.

Raheem O, Khandwala Y, Sur R, Ghani K, Denstedt J . Burden of Urolithiasis: Trends in Prevalence, Treatments, and Costs. Eur Urol Focus. 2017; 3(1):18-26. DOI: 10.1016/j.euf.2017.04.001. View

14.

Traxer O, Thomas A . Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2012; 189(2):580-4. DOI: 10.1016/j.juro.2012.08.197. View

15.

Geraghty R, Jones P, Herrmann T, Aboumarzouk O, Somani B . Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment: systematic review and meta-analysis. World J Urol. 2018; 36(11):1783-1793. PMC: 6208679. DOI: 10.1007/s00345-018-2320-9. View

16.

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M . EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2015; 69(3):475-82. DOI: 10.1016/j.eururo.2015.07.041. View

17.

Giusti G, Proietti S, Villa L, Cloutier J, Rosso M, Gadda G . Current Standard Technique for Modern Flexible Ureteroscopy: Tips and Tricks. Eur Urol. 2016; 70(1):188-194. DOI: 10.1016/j.eururo.2016.03.035. View

18.

Taylor E, Miller J, Chi T, Stoller M . Complications associated with percutaneous nephrolithotomy. Transl Androl Urol. 2016; 1(4):223-8. PMC: 4708158. DOI: 10.3978/j.issn.2223-4683.2012.12.01. View

19.

Kang H, Lee S, Kim W, Kim Y, Yun S, Lee S . Natural history of asymptomatic renal stones and prediction of stone related events. J Urol. 2012; 189(5):1740-6. DOI: 10.1016/j.juro.2012.11.113. View

20.

New F, Somani B . A Complete World Literature Review of Quality of Life (QOL) in Patients with Kidney Stone Disease (KSD). Curr Urol Rep. 2016; 17(12):88. PMC: 5075340. DOI: 10.1007/s11934-016-0647-6. View