The impact of surgical experience on outcomes of retrograde intrarenal surgery for kidney stones

Abstract

Objective: To evaluate the impact of surgical experience on the outcomes of retrograde intrarenal surgery (RIRS) to treat kidney stones. Material and Method: Retrospective chart review of patients who underwent RIRS between November 1st, 2014 and January 11th, 2017; the outcomes were divided into 2 groups. Group 1 was the less experienced surgeons (fewer than 30 cases for each surgeon) whereas group 2 was the highly experienced surgeon (more than 300 cases). The surgical outcomes, including operative time, stone-free rates, complications and scope damage, were compared between the 2 groups. Results: There were 6 surgeons in group 1 and a single surgeon in group 2. Seventy-four procedures were performed by group 1. Group 2 included the first 30 procedures after the surgeon had passed the learning curve. Patient demographic data, including age, sex and location of the stone, were not different between group 1 and group 2. Group 1 had a smaller stone size than group 2 (1.59 cm vs. 2.34 cm; p=0.006). The outcomes of group 2 were better than group 1, including operative time (80.48 minutes vs. 43.50 minutes; p<0.001) and stone-free rates (52.05% vs. 90%; p<0.001). Serious complications were determined to be sepsis or a high degree of ureter injury that required surgical correction. Sepsis occurred in 6 patients in group 1 (8.10%), whereas no sepsis was found in group 2 (p=0.013). There was no high degree of ureteric injury in either group. Three scopes were damaged in group 1 whereas no scope damage occurred in group 2 (p=0.045). Conclusion: RIRS is a popular procedure for the treatment of kidney stones. Surgical experience is mandatory to achieve excellent outcomes.Keywords: retrograde intrarenalsurgery, kidney stone, surgical experience