PD18-09 SHOULD STONE REMOVAL BE DONE AFTER STONE FRAGMENTATION IN THE MANAGEMENT OF UPPER URINARY SYSTEM STONES?

Abstract

INTRODUCTION AND OBJECTIVES: The aim of this study was to present whether or not the fragmented stones to be removed with the nitinol basket after laser fragmentation has any impact on the outcomes in the management of intrarenal stones. METHODS: Patients with upper urinary system stones (stone burden between 10 mm and 40 mm) who underwent RIRS (retrograde intrarenal surgery) were included. Patients were allocated into two groups. Group 1 consisted of patients who underwent RIRS but no basket catheters were used. Whereas, basket catheters were used during RIRS on patients in Group 2 for stone removal after stone fragmentation. After ureteral access sheath was inserted into the ureter, the flexible ureterorenoscope was then advanced inside the access sheath up to the kidney. All stone pieces were fragmented roughly down to 1⁄43 mm in size. Stone fragments were removed with a nitinol basket according to surgeon’s discretion. SFR (Stone free rates) was defined as no fragments or the presence of clinically insignificant residual fragments smaller than 4 mm in the urinary system. RESULTS: A total of 268 operations on 247 patients were included in the present study. Patients’ demographics data and preoperative stone characteristics in each group are detailed in Table 1. Intraoperative and postoperative results between two groups are shown in Table 2. Mean operative time was significantly longer in group 2 (p1⁄40.001). Use of nitinol basket (Group 2) for the removal of stone fragment following stone fragmentation increased the mean operative time for 15.4 13.1 minutes on average compared to that in Group 1. The complication rates were not statistically different between the groups (p1⁄40.313; ?21⁄40.451). Overall SFR were 87.8%, and 92.1% in groups 1, and 2, respectively (p1⁄40.164; ?21⁄41.406). CONCLUSIONS: Use of nitinol basket after stone fragmentation with holmium laser prolongs operative times, but it does not change SFR. Therefore use of nitinol basket after stone fragmentation intending stone free status is not realistic.