Lower Pole Stones Research Articles

Place For Percutaneous Nephrolithotomy In Contemporary Era

Background : Percutaneous nephrolithotomy (PCNL) and its miniaturized modifications are usually considered the standard surgical options for large (>20 mm) stag horn and infected stones. Moreover, PCNL is a viable alternative to retrograde intrarenal surgery (RIRS) for smaller stones (<20 mm) in the presence of anatomical malformations or inaccessible lower pole stones. However, due to theinnovations in stone fragmentation devices and optical technologies, RIRS is expanding its indications with the potential benefits of lower complications and a shorter hospital stay. Recent research papers presently published confirm the significance of this procedure and its potential role in the treatment of large and complex stones. On the other hand miniaturized PCNL has become more competitive, gaining space among classic indications of flexible ureteroscopy. Considering all recent progress incorporated in performance of this procedure, we can conclude that PCNL is definitely time tested procedure and is here to maintain its cutting edge supremacy in the foreseeable future. Key words: Percutaneous Nephrolithotomy ,Kidney Stones, Urological Surgery

Vacuum-assisted dedusting lithotripsy in the treatment of kidney and proximal ureteral stones less than 3cm in size.

This study aimed to compare the outcomes of vacuum-assisted dedusting lithotripsy (VADL) using flexible vacuum-assisted ureteral access sheath (FV-UAS) versus traditional flexible ureteroscopic lithotripsy (fURL) in patients with kidney or proximal ureteral calculi less than 3cm in size. A total of 371 patients who successfully underwent fURL treatment were enrolled. These patients were divided into traditional fURL group and VADL group. Outcomes of both groups were compared using 1:1 propensity score-matched analysis. Stratified analyses based on stone size and location were also conducted. Finally, 103 well-matched patients in each group were identified. No septic shock or death occurred. The immediate stone-free rate (SFR) and follow-up SFR of VADL group were significantly higher (78.6% vs. 50.5%, p < 0.001; 94.2%% vs. 75.7%, p < 0.001). No difference was observed in postoperative fever rate (2.9% vs. 3.9%, p = 1.000) and duration of lithotripsy (37.7 ± 20.1min vs. 40.3 ± 18.9min, p = 0.235). For patients with stones ≤ 2cm in size, the immediate SFR and follow-up SFR in VADL group were higher (86.7% vs. 60.6%, p < 0.001; 96.0% vs. 83.1%, p = 0.010). The same trend was observed in the 2-3cm subgroup (57.1% vs. 28.1%, p = 0.023; 89.3% vs. 59.4%, p = 0.009). Although the in situ fragmentation strategy was employed more frequently in VADL group for lower pole stones, the SFR was still higher. Subgroup analyses did not reveal any significant differences in either infectious complications or duration of lithotripsy. VADL technique can significantly improve the postoperative SFR for the patients with kidney or proximal ureteral stones less than 3cm in size treated by flexible ureteroscope.

Effect of external physical vibration lithecbole in obese patients with lower pole stones

To investigate the efficacy and safety of external physical vibration lithecbole (EPVL) in obese patients with <15 mm lower pole stones following extracorporeal shock wave lithotripsy (ESWL). Two hundred and ninety-nine obese patients with BMI greater than 30 kg/m2 and lower pole stones smaller than 15 mm were prospectively randomized into two groups. While ESWL was the only option in the control group, patients in the treatment group accepted EPVL after receiving ESWL. Imaging tests were used to compare the stone expulsion status on day 1 and the stone-free rates (SFR) on the first, second, and fourth weekends. All 299 obese patients were randomly divided into two groups, with 152 patients assigned to the treatment group and 147 assigned to the control group. EPVL was effective in facilitating the expulsion of stone fragments. The treatment group's stone expulsion rate on the first day following EPVL was significantly greater than the control group's (66.4% vs. 51.7%, p = 0.009). Stone clearance rates in the treatment and control groups were 63.2 and 55.1% at 1 week (p = 0.041), 84.9 and 70.7% at 2 weeks (p = 0.011), and 90.8 and 79.6% at 4 weeks (p = 0.017), respectively. The complications (hematuria, lumbago, and fever) between the groups did not show any significance (p > 0.05). Patients in the treatment group received an average of 5.2 sessions. EPVL is an efficient and secure procedure that facilitates lower pole stone discharge in obese patients following ESWL treatment. To support the aforementioned conclusions, additional large-scale multi-center prospective studies are required.

Extracorporeal shock wave lithotripsy for lower calyx stones: predicting treatment success

IntroductionThe use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. MethodsRetrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3 mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment.Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p = 0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p = 0.000), size of the stone (p = 0.001), number of shock waves (p = 0.003), energy applied (p = 0.038) and the need for additional treatment after ESWL. ConclusionsESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Litotricia extracorpórea por ondas de choque (LEOCh) Para litiasis de grupo calicial inferior: ¿cómo predecir el éxito del tratamiento?

IntroductionThe use of extracorporeal shock wave lithotripsy (ESWL) for lower calyx stones is associated with a high rate of residual fragments. Our aim is to analyse the effectiveness and complications of ESWL for lower calyx stones. MethodsRetrospective review of patients with lower renal calyx stones treated with ESWL between January-2014 and December-2020. Measurement of infundibular length, infundibular width and infundibulopelvic angle in lower renal pole to determine favourable anatomy. ESWL failure: fragments >3mm detected in plain abdominal film, CT scan and/or renal ultrasound 3 months after treatment.Complications after ESWL, auxiliary procedures along with risk factors associated with perirenal haematoma were analysed. SPSS statistical software was used. Results512 patients with lower calyx stones were treated with ESWL. 80.3% of patients had a favourable anatomy. Overall stone-free rate was 70.5%. Regarding main complications after ESWL, stainstrasse was described in 5 patients and urinary tract infection in 3 patients. 10 perirenal haematomas (2%) were reported. Statistical association was found between antiplatelet treatment and the risk of perirenal haematoma (p=0.004). Logistic binary regression proved the association between unfavourable anatomy of the lower renal pole (p=0.000), size of the stone (p=0.001), number of shock waves (p=0.003), energy applied (p=0.038) and the need for additional treatment after ESWL. ConclusionsESWL can still be considered as the initial treatment option for lower renal pole stones. The size of the stone, an unfavourable anatomy of the lower renal calyx, number of shock waves and energy applied can help predict the need for additional treatment.

Percutaneous nephrolithotomy using fluoroscopic guided renal access

Objective: To report our experience of over 500 patients treated with Percutaneous nephrolithotomy (PCNL) at a tertiary as well as secondary Care hospital. Despite PCNL's early success as a minimally invasive treatment option, its popularity has waned after the advent of extracorporeal shockwave lithotripsy (ESWL). Over time, however, urologists were forced to rethink the role of PCNL in the treatment of Urolithiasis after clinical experience with ESWL revealed its limitations, particularly for lower pole stones with anatomical complexity and the challenges faced for open surgical procedures, particularly stones in an intrarenal pelvis. Urologists have advanced into the era of ever-expanding PCNL versatility thanks to advancements in tools, camera systems, and intracorporeal lithotripsy technology, and they now have expert skills of percutaneous stone dissolution in to all parts of the kidney. Patients and Methods: Between 2013 and 2019, 500 participants (358 males, 142 females, and aged 15-55 years) were addressed with PCNL by a single Urologist in our institution at both a tertiary care hospital and a secondary care hospital. Stones averaged 2.5 cm in diameter (ranging from 1.5 to 3.5 cm).

Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR).

Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes. A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded. Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001). RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

Influencia del sexo en los resultados de la cirugía retrógrada intrarrenal (CRIR). Datos obtenidos del Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characterictis was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

Stone attenuation on computer tomography helps surgeons make decisions between miniaturized percutaneous nephrolithotomy or retrograde intrarenal surgery for lower pole stones: a retrospective study

A retrospective study was performed on 200 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) for 10-20mm sized lower pole renal calculi to investigate the relationship between computed tomography (CT) attenuation of calculi and surgical outcomes. CT was used to examine the location, size, and CT attenuation values of the calculi. Additionally, the operation time, hospital stay, hemoglobin (Hb) reduction, stone-free rate (SFR), and complication rate were also meticulously documented and subjected to comparative analysis. Complications were assessed using the Clavien-Dindo grading system. We observed no significant differences in hospitalization data and follow-up outcomes, except for a longer hospital stay and higher Hb drops in patients receiving mini-PCNL. Statistical analysis revealed an association between CT attenuation and operation time. Compared with mini-PCNL, RIRS could reduce bleeding, hospital stay, surgery time, and complications for 10-20mm sized lower pole kidney stones with CT values < 1000 HU. RIRS resulted in longer operation time and lower stone-free rates despite shorter hospital stays and less bleeding than mini-PCNL for stones with CT values > 1000 HU. Therefore, selecting an appropriate surgical method based on CT attenuation might improve outcomes. For patients with stone attenuation values < 1000 HU, RIRS is the recommended option. When stone attenuation values > 1000 HU, the surgical method should be chosen based on the patient's individual situation.

A Comparative Study on Outcomes of Retrograde Intrarenal Surgery (RIRS), Mini Percutaneous Nephrolithotomy (PCNL), and Extracorporeal Shock Wave Lithotripsy (ESWL) for Lower Pole Renal Calculi of &lt; 1.5 cm

Background: Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases. Objectives: Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of &lt; 1.5 cm. Methods: This observational study encompassed all patients with lower pole renal stones with &lt; 1.5 cm diameter and &lt; 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed. Results: The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031). Conclusions: For lower pole renal calculi &lt; 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

MP35-06 DOES GENDER HAVE ANY INFLUENCE ON RIRS OUTCOMES? DATA FROM THE FLEXIBLE URETEROSCOPY OUTCOMES REGISTRY (FLEXOR)

V02-06 ULTRA-LOW DOSE FLUOROSCOPY DURING PCNL: HOW LOW CAN YOU GO?

You have accessJournal of UrologyCME1 Apr 2023V02-06 ULTRA-LOW DOSE FLUOROSCOPY DURING PCNL: HOW LOW CAN YOU GO? Vance Gentry, Kanha Shete, Ala'a Farkouh, Alphie Rotinsulu, Matthew Buell, Rose Leu, Akin S. Amasyali, Matthew Wilson, Joel Pearson, and D. Duane Baldwin Vance GentryVance Gentry More articles by this author , Kanha SheteKanha Shete More articles by this author , Ala'a FarkouhAla'a Farkouh More articles by this author , Alphie RotinsuluAlphie Rotinsulu More articles by this author , Matthew BuellMatthew Buell More articles by this author , Rose LeuRose Leu More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Matthew WilsonMatthew Wilson More articles by this author , Joel PearsonJoel Pearson More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients diagnosed with renal stones may be subjected to substantial doses of ionizing radiation during diagnosis, treatment, and follow-up. Physicians and other healthcare workers are also exposed to radiation during procedures, such as percutaneous nephrolithotomy (PCNL). This puts both patients and surgeons at the risk of developing radiation-related deleterious outcomes, like malignancies. The purpose of this video is to demonstrate tips and tricks that can be used to reduce radiation exposure during PCNL. METHODS: In this video, we demonstrate techniques to reduce radiation exposure to both patients and surgeons, in an 86-year-old female with a 2 cm renal pelvic and 8 mm lower pole stones who underwent PCNL at an academic center. These steps include planning for surgery, equipment set-up and calibration, use of personal protective equipment (PPE), use of multiple modalities to guide access into the renal pelvis, omitting fluoroscopy from various steps of the surgery, and a low dose CT for follow-up imaging. RESULTS: This video demonstrates a successful PCNL with a total fluoroscopy time of 5.6 seconds. Radiation reduction was achieved preoperatively by reviewing CT scans before surgery to plan access. Intraoperatively all of the following were employed: using a sterile ultrasound to map out a safe zone, relying on tactile feedback instead of fluoroscopy for retrograde glidewire placement into renal pelvis, use of endoscopic combined intrarenal surgery (ECIRS) for renal access, tract dilation, and sheath placement, appropriate use of lead shielding, using pulsed low-dose fluoroscopy, and using laser to guide percutaneous access into the renal pelvis. Post-operatively, ultra-low-dose 7.5 mAs CT scan was used to check for residual stones. CONCLUSIONS: This video has demonstrated many radiation-reducing techniques to both patient and surgeon, all of which can be easily incorporated into daily practice. By following these techniques, we effectively lowered radiation exposure to half the dose of a KUB. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e169 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vance Gentry More articles by this author Kanha Shete More articles by this author Ala'a Farkouh More articles by this author Alphie Rotinsulu More articles by this author Matthew Buell More articles by this author Rose Leu More articles by this author Akin S. Amasyali More articles by this author Matthew Wilson More articles by this author Joel Pearson More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM

You have accessJournal of UrologyCME1 Apr 2023MP35-19 A PROSPECTIVE RANDOMISED CONTROLLED STUDY BETWEEN MINIPCNL AND RIRS USING THULIUM FIBER LASER FOR LOWER POLE STONES 10-20 MM Chandra Mohan Vaddi, Ramakrishna Paidakula, Siddalinga Swamy P. M., Soundarya Ganesan, Hemnath U. A., Manas Babu B., and Rakesh Panda Chandra Mohan VaddiChandra Mohan Vaddi More articles by this author , Ramakrishna PaidakulaRamakrishna Paidakula More articles by this author , Siddalinga Swamy P. M.Siddalinga Swamy P. M. More articles by this author , Soundarya GanesanSoundarya Ganesan More articles by this author , Hemnath U. A.Hemnath U. A. More articles by this author , Manas Babu B.Manas Babu B. More articles by this author , and Rakesh PandaRakesh Panda More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.19AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) has been recommended as the first choice for lower pole stone >10 mm. The objective of the study is to analyse whether Retrograde intrarenal surgery (RIRS) with newly upcoming Thulium fiber laser (TFL) can be an equally effective alternative. Primary Aim: To compare the different treatment modalities in terms of efficacy (stone free rate, need for auxiliary procedures) and safety (complication rate).Secondary aim: To compare the perioperative outcomes (operative time, fluoroscopic time, length of hospitalization). METHODS: Study Design: Prospective randomised controlled study Study period: October 2021 – May 2022 Study Population: Patients with lower pole stones 10-20 mm Group A - RIRS, Group B – Mini PCNL The energy source used was 60 W TFL (IPG Photonics, Massachusetts, United States) in both Group A and B. NCCT KUB was done at 2 months post operatively to calculate stone free rate. Institutional Ethics Committee approval was obtained. RESULTS: Mean stone size was 13.93±2.92 mm in Group A and 15.04±3.18 mm in Group B. In Group A, fluoroscopy time was significantly lower (31.96±14.34 vs 337.68±131.85, p<0.001), hospital stay was significantly lower (1.37±0.63 vs 3.24±1.01, p<0.001) and stone free rate (SFR) was comparable to Group B (88.9% vs 92.3%, p=1.000). There was no significant difference in operative time, complication rate or need for auxiliary procedure (Table 1). The ablation speed was significantly higher (9.47±5.61 vs 1.55±1.95, p<0.001), the laser efficacy was significantly lower (3.18±3.83 vs 16.43±7.07, p<0.001) and the laser time was significantly lower (141.04±86.98 vs 992.63±488.30, p<0.001) in Group B, as fragmentation rather than dusting was done with TFL. Table 1 CONCLUSIONS: RIRS with TFL for lower pole stones has SFR comparable to MiniPCNL, lower fluoroscopy time and hospital stay. No significant difference was found in operative time, complication rate or requirement of auxiliary procedure. Thus, RIRS with TFL is an effective alternative to miniPCNL for lower pole stones 10-20 mm Parameter RIRS with TFL (n=25) MiniPCNL with TFL(n=25) P value Age (years) 44.52 ± 14.21 48.64 ± 12.70 0.5091 Stone Size (mm) 13.93 ± 2.92 15.04 ± 3.18 0.1441 Volume (mm³) 1016.72 ± 341.11 1037.08 ± 428.83 0.4641 Density (HU) 1111.44 ± 252.61 1181.12 ± 288.14 0.3603 Operative Time (Minutes) 48.63 ± 8.57 50.80 ± 15.13 0.4521 Fluoroscopy Time (sec)*** 31.96 ± 14.34 337.68 ± 131.85 <0.0011 Complication rate 4/27 (14.8%) 5/25 (20%) 0.2134 Hospital Stay (Days)*** 1.37 ± 0.63 3.24 ± 1.01 <0.0011 Duration of Follow-Up 7.97 ± 2.47 8.29 ± 2.66 0.6503 Auxiliary Procedure (Yes) 2 (7.4%) 1 (4.0%) 1.0004 Overall Stone free rate 88.9% 92.3% 1.0004 ***Significant at p<0.05, 1: Wilcoxon-Mann-Whitney U Test, 2: Chi-Squared Test, 3: t-test, 4: Fisher's Exact Test Source of Funding: Self © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e477 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chandra Mohan Vaddi More articles by this author Ramakrishna Paidakula More articles by this author Siddalinga Swamy P. M. More articles by this author Soundarya Ganesan More articles by this author Hemnath U. A. More articles by this author Manas Babu B. More articles by this author Rakesh Panda More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The efficacy of retrograde intra-renal surgery (RIRS) for lower pole stones: results from 2946 patients

PurposeTo evaluate the perioperative outcomes of retrograde intra-renal surgery (RIRS) for lower pole stones (LPS) and factors affecting stone-free rate (SFR).MethodsData from 20 centers were retrospectively reviewed. Inclusion criteria were adult patients, normal renal anatomy, and LPS. Exclusion criteria were bilateral surgery, concomitant surgery for ureteral stones. SFR was defined as a single residual fragment (RF) ≤ 2 mm and evaluated 3-months after surgery. A multivariable logistic regression analysis was performed to assess factors associated with RF. Statistical significance was set at p value < 0.05.Results2946 patients were included. Mean age and stone size were 49.9 years 10.19 mm, with multiple LPS in 61.1% of cases. Total operation and laser time were 63.89 ± 37.65 and 17.34 ± 18.39 min, respectively. Mean hospital stay was 3.55 days. Hematuria requiring blood transfusion and fever/urinary infections requiring prolonged antibiotics occurred in 6.1% and 169 5.7% of cases, while sepsis with intensive-care admission in 1.1% of patients. On multivariate analysis, Multiple stones (OR 1.380), stone size (OR 1.865), and reusable ureteroscopes (OR 1.414) were significantly associated with RF, while Thulium fiber laser (TFL) (OR 0.341) and pre-stenting (OR 0.750) were less likely associated with RF.ConclusionsRIRS showed safety and efficacy for LPS with a mean diameter of 10 mm. This procedure can achieve a satisfactory SFR in pre-stented patients with a single and smaller stone, particularly with TFL use.

Do Hounsfield Units have any significance in predicting intra- and postoperative outcomes in retrograde intrarenal surgery using Holmium and Thulium fiber laser? Results from the FLEXible ureteroscopy Outcomes Registry (FLEXOR).

To evaluate outcomes of flexible ureteroscopy for renal stones by comparing hard versus soft stones based on their attenuation on computed tomography (Hounsfield Units-HU). Patients were divided into two groups according to the type of laser employed [Holmium:YAG (HL) or Thulium fiber laser (TFL)]. Residual fragments (RF) were defined as > 2mm. Multivariable logistic regression analysis was performed to evaluate factors associated with RF and RF needing further intervention. 4208 patients from 20 centers were included. In whole series, age, recurrent stones, stone size, lower pole stones (LPS), and multiple stones were predictors of RF at multivariable analysis and LPS and stone size with RF requiring further treatment. HU and TFL were associated with lesser RF and RF requiring an additional treatment. In HU < 1000 stones, recurrent stones, stone size, and LPS were predictors of RF at multivariable analysis, whereas TFL was less likely associated with RF. Recurrent stones, stone size, and multiple stones were predictors of RF requiring further treatment, while LPS and TFL were associated with lesser RF requiring further treatment. In HU ≥ 1000 stones, age, stone size, multiple stones, and LPS were predictors of RF at multivariable analysis, while TFL was less likely associated with RF. Stone size and LPS were predictors of RF requiring further treatment, whereas TFL was associated with RF requiring further treatment. Stone size, LPS, and use of HL are predictors of RF after RIRS for intrarenal stones regardless of stone density. HU should be considered an important parameter in predicting SFR.

Outcomes in Lower Pole Kidney Stone Management Using Mini-Percutaneous Nephrolithotomy Compared With Retrograde Intra Renal Surgery: A Randomized Controlled Trial.

Background Because of the anatomical properties of the inferior calyx, lower pole stones are difficult to remove through the ureter, even if the stones are fragmented. Retrograde intra-renal surgery (RIRS) is typically employed to treat the smaller lower pole stones (1.0-2.0 cm) while percutaneous nephrolithotomy (PCNL) is primarily used to treat the larger diameter stones or when RIRS has failed to clear the stones. This study was conducted to compare mini-PCNL and RIRS for the management of lower pole kidney stones in terms of stone clearance. Material and methods This randomized control trial was conducted in the Department of Urology, Shaikh Zayed Hospital, Lahore from October 2020 to December 2022. A total of 150 patients between the ages of 18 and 80 years with a kidney stone size of 10-20 mm at the lower pole were included. Patients with positive urine culture, anatomical abnormalities, uncontrolled diabetes (hemoglobin{Hb}A1c >9%), and undergone previous renal surgery were excluded. Group A patients were treated with mini-PCNL, while group B patients were managed with RIRS. Follow-up visits were planned four weeks postoperatively with CT KUB (computed tomography of kidneys, ureters, and bladder) plain to assess stone clearance. Results The mean age in group A was 43.27 ± 13.86 years, while in group B was 45.32 ± 14.14 years. Out of 150 patients, 102 (68.0%) were males and 48 (32.0%) were females. Mean size of the stone was 15.30 ± 2.21 mm. Stone clearance after mini-PCNL was found in 69 (92.0%) patients and after RIRS in 59 (78.67%) patients (p-value = 0.021). Mean hospital stay after RIRS was 1.1 ± 0.09 days, while it was 2.3 ± 0.64 days after mini-PCNL (p-value < 0.001). Two (2.67%) patients in the mini-PCNL group developed bleeding postoperatively. The stone clearance rate in older patients (51 to 80 years) was significantly higher in the mini-PCNL group than RIRS group. Similarly, the stone clearance rate in female patients and in patients with larger stones (16 to 20 mm) was found to be higher in mini-PCNL group as compared to the RIRS group. Conclusion This study concluded that both mini-PCNL and RIRS are safe and efficient techniques for treating lower pole kidney stones with a size of 11-15 mm. However, mini-PCNL has a higher stone clearance rate compared to RIRS in the treatment of stones larger than 15 mm in size. This study further suggested that patients treated with mini-PCNL had a longer hospital stay compared to patients treated with RIRS.

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No AccessJournal of UrologyAdult Urology23 Feb 2023Reply by Authorsis a reply to letterEditorial Comment Alan J. Yaghoubian, Harry Anastos, Johnathan A. Khusid, Roman Shimonov, Dara J. Lundon, Raymond Khargi, Blair Gallante, Kyra Gassmann, Jacob N. Bamberger, Ryan Chandhoke, Anna Zampini, William Atallah, and Mantu Gupta Alan J. YaghoubianAlan J. Yaghoubian *Correspondence: Department of Urology, Mount Sinai Medical Center: Mount Sinai Health System, Gustave L. Levy Pl, New York, NY 10029 telephone: 212-241-1272; E-mail Address: [email protected] Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Harry AnastosHarry Anastos Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Johnathan A. KhusidJohnathan A. Khusid Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Roman ShimonovRoman Shimonov Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Dara J. LundonDara J. Lundon Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Raymond KhargiRaymond Khargi Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Blair GallanteBlair Gallante Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , Kyra GassmannKyra Gassmann Downstate Health and Sciences University, College of Medicine, Brooklyn, New York More articles by this author , Jacob N. BambergerJacob N. Bamberger Downstate Health and Sciences University, College of Medicine, Brooklyn, New York More articles by this author , Ryan ChandhokeRyan Chandhoke Department of Urology, Kaiser Permanente, San Diego, California More articles by this author , Anna ZampiniAnna Zampini Department of Urology, Cleveland Clinic, Cleveland, Ohio More articles by this author , William AtallahWilliam Atallah Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author , and Mantu GuptaMantu Gupta Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003199.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Reply by Authors." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCE 1. Displacement of lower pole stones during retrograde intrarenal surgery improves stone-free status: a prospective randomized controlled trial. J Urol.2023; 209(5):000-000. Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology23 Feb 2023Editorial Comment Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Yaghoubian Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York *Correspondence: Department of Urology, Mount Sinai Medical Center: Mount Sinai Health System, Gustave L. Levy Pl, New York, NY 10029 telephone: 212-241-1272; E-mail Address: [email protected] More articles by this author Harry Anastos Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Johnathan A. Khusid Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Roman Shimonov Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Dara J. Lundon Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Raymond Khargi Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Blair Gallante Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Kyra Gassmann Downstate Health and Sciences University, College of Medicine, Brooklyn, New York More articles by this author Jacob N. Bamberger Downstate Health and Sciences University, College of Medicine, Brooklyn, New York More articles by this author Ryan Chandhoke Department of Urology, Kaiser Permanente, San Diego, California More articles by this author Anna Zampini Department of Urology, Cleveland Clinic, Cleveland, Ohio More articles by this author William Atallah Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Mantu Gupta Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York More articles by this author Expand All Advertisement PDF downloadLoading ...

A prospective randomised controlled study between miniPCNL and RIRS using thulium fiber laser for lower pole stones 10-20mm

A prospective randomised controlled study between miniPCNL and RIRS using thulium fiber laser for lower pole stones 10-20mm