Open Renal Stone Surgery Research Articles

Comparative Study Between Percutaneous Nephrolithotomy in Patients with and without History of Open Renal Stone Surgery

Comparative Study Between Percutaneous Nephrolithotomy in Patients with and without History of Open Renal Stone Surgery

Comparison of Percutaneous Nephrolithotomy Success Rate and Complications in Patients with a History of Different Therapeutic Interventions for Kidney Stone

Background: Percutaneous nephrolithotomy (PCNL) is one of the five interventions offered to patients with renal stones. Objectives: This study compared the effects of previous therapeutic interventions for renal stones on subsequent PCNL regarding success rate and complications. Methods: In this descriptive-analytical study, the data from 375 patients who had undergone PCNL were reviewed retrospectively. Patients were categorized into four groups based on their previous therapeutic interventions as no history of open renal stone surgery (n = 196), PCNL (n = 64), extracorporeal shockwave lithotripsy (ESWL) (n = 88), and open surgery (n = 27). We compared surgery duration, the surgical procedure's success rate, complications, as well as the site and size of the stone between the groups. Results: The mean operation duration was significantly longer in the fourth group (61.66 ± 19.85), while there were no statistically significant differences in surgery duration between other groups (P = 0.88). The mean hospital stay, stone size, and site were also similar between the groups. All groups had a high number of pelvic stones, and the rate of upper calyceal stones was higher than middle calyceal and ureteral stones in all groups. Access time was higher in groups one and four, but no significant difference was observed (P = 0.31). Grade 1 and 2 complications were frequent among the patients. The overall immediate success rate was high in all groups. Conclusions: The present study indicates that patients with a history of open surgery for kidney-related conditions may have higher blood loss and longer surgery duration, likely due to anatomical and histological changes in the kidney.

A prospective comparative study of percutaneous nephrolithotomy in patients with and without a history of open stone surgery

Background & Objectives: Percutaneous nephrolithotomy in individuals with prior open stone operations might be difficult. The purpose of our research was to compare the efficacy and complications of the procedure in individuals who had previous open renal stone surgeries with patients without previous open renal surgeries. Methods: This is a prospective comparative study carried out on 115 patients between May 2020 to April 2021, the patients were classified into two groups. Group 1 (n=50) had previously undergone open renal stone surgery. Group 2 (n=65) had no prior open operations. Both groups' demographic data, stone parameters, operative and fluoroscopy time, stone-free rate, hospital stays, and perioperative and postoperative complications were compared. Results: The demographic data and stone parameters were comparable between the two groups, the total operative time and fluoroscopic time were significantly higher for group 1 versus group 2 (74.18 min vs 62.89 min), (22.12 min vs 11.69 min) respectively. Postoperative hospital stays nephrostomy tube removal time, and mean hemoglobin drops were also similar, 6 patients in group 1 received a blood transfusion in comparison to 2 patients in group 2, but statistically was not significant. There were no statistically significant differences between groups 1 and 2 in terms of perioperative and postoperative complications. Conclusion: Individuals with a history of open renal stone operations who have subsequent percutaneous nephrolithotomy may require more fluoroscopic and operating time, although the success rate and overall morbidities were the same in both groups.

Outcome of Percutaneous Nephrolithotomy in Patients with History of Open Renal Stone Surgery

Background: Percutaneous nephrolithotomy (PCNL) in patients operated previously for renal stone are thought to pose some difficulties. Objective: To see the outcome of PCNL in patients who had undergone open surgery for renal stone. Method: This cross sectional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka from November 2015 to October 2016 over a period of one year. Thirty cases with recurrent stone having previous open renal stone surgery were enrolled as study subject. After PCNL all the patients were followed up at one week, one month and three months after procedure. Result: Mean age of the patients was 40.90 ± 6.08 years and mean stone size was 2.98 ± 0.65 cm. Mean operation time of the patients was 1.50 ± 0.46 hours and mean postoperative hospital stay was 3.87 ± 1.13 days. Stone was cleared from 29 (96.7%) patients. Mean drop of Haemoglobin level was 0.85 ± 0.55 mg/dl. Conclusion: Previous open stone surgery does not alter the outcome of subsequent PCNL. Bangladesh J. Urol. 2021; 24(1): 58-61

Robot-assisted partial nephrectomy and nephrolithotomy for multiple lower pole calculi in an atrophic kidney

Open renal stone surgery has been largely replaced by retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL). However, when these methods fail to remove a stone or there are certain contraindications, such as pregnancy and obesity, laparoscopic, robotic or open surgery may still be indicated. In fact, robotic surgery has been increasingly used by urologists for different benign indications including chronic pyelonephritis, neglected ureteropelvic junction obstruction and renal tuberculosis. This article describes a case of robotic-assisted partial nephrectomy and nephrolithotomy for a large amount of small lithiasis in a non-functioning lower pole after failed stone clearance with a single use Boston ureteroscope owing to non-accessibility.

Percutaneous nephrolithotomy in previously operated patients: A prospective study

Purpose:To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL).Materials and Methods:Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system.Results:There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference.Conclusion:PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.

Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery.

Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time. A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups. This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery.

Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

Introduction: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS). Methods: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications. Results: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively). Conclusion: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

Böbrek Taşı Olan Çocuklarda Önceki Taş Tedavisinin Perkütan Nefrolitotomi Sonuçlarına Etkisi

Objective: In this single center study, we aimed to compare perioperative outcomes of PCNL in pediatric patients with and without history of previous stone treatments including open renal stone surgery, PCNL, and shockwave lithotripsy (SWL). Material and Methods: We retrospectively evaluated children under 18 years of age who underwent PCNL operation between 2008 and 2016 in our clinic. Cases were further divided into two groups: patients with a history of open renal surgery or PCNL or failed SWL on the same side were categorized as group 1, primary PCNL patients were categorized as group 2. Demographic data, preoperative and operative data were compared between the selected two groups. We used kidney-ureter-bladder radiography (non-contrast-enhanced computed tomography in cases with non-opaque stones) that performed 6 weeks postoperatively for the assessment of residual stones (≥4mm). Postoperative complications were recorded according to modified Clavien classification. Residual stone rates and complications of PCNL were compared between the two groups. Results: The study included 122 PCNL cases with mean±SD age of 7.14±4.86 years. 35 of the 122 PNL cases (28.69%) had a history of previous stone treatment for the same side kidney stone. There was no statistically significant difference between the two groups in terms of change in hemoglobin values (p=0.997), operation time (p=0.584) and hospital stay (p=0.997). No statistically significant difference was found the residual stone rates (p=0.365) and postoperative com- plications (p=0.886), as well. No statistically significant differences were found between the groups for the rates of residual stones (p=0.365) and postoperative complications (p=0.886), as well. Conclusion: The results of this study demonstrate that PCNL can be safely performed in children with previous stone treatment.

Does Previous Open Renal Stone Surgery Affect the Outcome of Extracorporeal Shockwave Lithotripsy Treatment in Adults with Renal Stones?

To evaluate the effects of previous ipsilateral open renal stone surgery (ORSS) on outcomes of extracorporeal shockwave lithotripsy (SWL) in adults with renal stones. A total of 2097 renal units with renal stones underwent SWL treatment at our institution between March 1997 and February 2013. One thousand eight hundred thirty-nine (87.7%) of these had no history of ORSS and were categorized as group 1, and 258 (12.3%) patients having history of ipsilateral ORSS were categorized as group 2. Characteristics of patients, stone and treatment, stone-free, and complications rates were documented in detail and compared in each group. These groups were also subclassified into four subgroups according to the stone location. The stone-free rates were statistically higher in group 1 than group 2 (73.2% and 61.6%, respectively). There were no differences between groups regarding the complications and steinstrasse. The stone-free rate of SWL for stones located at lower calix has significant difference according to groups 1 and 2 (64% vs 48.4%, p = 0.001). Logistic regression analysis showed that history of ORSS increased SWL failure rate 1.39 times. Overall stone-free rates after SWL treatment was found to be significantly lower in patients with the history of ORSS than in patients without, and this finding was significantly prominent for lower calix stones. We believe that retrograde intrarenal surgery or mini- /micro-percutaneous nephrolithotripsy, despite its possible difficulties in accessing due to anatomical changes, might be a good alternative for SWL.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = &lt; 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years.

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

Outcome of percutaneous nephrolithotomy in patients with history of open renal surgery - a comparative study with PCNL in primary patients

Percutaneous nephrolithotomy (PCNL) in patients operated previously for renal stone are thought to pose some difficulties. This study was carried out to compare the outcome of PCNL in patients who had undergone open surgery for renal stone with the outcome in primary patients. This descriptive cross sectional study was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University, Dhaka during the period of Nov 2012 to Oct 2013. Sixty patients with renal stone admitted in urology department were selected of which 30 cases were with recurrent stone having previous open renal stone surgery (group I - study group) and another 30 were primary patients without previous surgery for renal stone disease (group II - control). After PCNL all the patients were followed at one week, one month and three months after procedure. Mean ages of Group I and Group II were 40.90 ± 6.08 years and 44.10 ± 9.91 years respectively. Mean stone size of the respondents in Group I was 2.98 ± 0.65 cm and in Group II was 3.03 ± 0.67 cm. Mean operation time of the respondents in Group I and Group II were 1.50 ± 0.46 and 1.52 ± 0.33 hours respectively. Mean post-operative hospital stay of the respondents in Group I was 3.87 ± 1.13 days and Group II was 3.67 ± 0.60 days. Stone was cleared from 29 (96.7%) patients in Group I and 28 (93.3%) patients in Group II. Mean drop of Haemoglobin level were 0.85 ± 0.55 mg/dl and 0.94 ± 0.52 gm/dl in group I and group II respectively. It was evident from the study that previous open stone surgery does not alter the outcome of subsequent PCNL.Bangladesh Med J. 2016 Jan; 45 (1): 36-39

The effects of previous open renal stone surgery types on PNL outcomes.

Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes. Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study. 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%). Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.

The Effect of Surgical Stress on Serum Prostate Specific Antigen Level

Objective: Invasive surgical interventions creating acute stress may give rise to immunological and hormonal disturbances in patients undergoing surgery. Previous studies reported elevations in serum prostate-specific antigen (PSA) level following coronary bypass and myocardial infarction. The current study aims to investigate the effect of surgical stress on serum PSA level. Methods: Thirty-three patients who underwent open renal stone surgery, without any known infectious prostatic disorder or prostate cancer that may elevate serum PSA level, were included in the study. In all patients, serum levels of total and free PSA (tPSA and fPSA), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total and free testosterone, C-reactive protein (CRP), fibrinogen, albumin, and ferritin and erythrocyte sedimentation rate (ESR) were measured both at baseline and post-operative day 3. Wilcoxon signed-rank test was used for the statistical analysis. Results: The mean age of patients was 53.9±8 (40-66). The mean baseline and post-operative levels of the measured serum parameters are given in Table 1. All of them differed significantly between baseline and post-operative day 3, except for LH, tPSA, and fPSA. CRP, fibrinogen, ferritin, and ESR are known as acute phase reactants of the post-operative endocrine response. However, serum total and free testosterone levels, albumin, and FSH decreased on the contrary acute phase reactants in the present study. Conclusion: According to our results, serum PSA level was not affected by acute surgical stress. (JAREM 2015; 5: 22-4)

590 Open renal stone surgery: Is it still there?

590 Open renal stone surgery: Is it still there?

Retrograde Intrarenal Surgery in Patients Who Previously Underwent Open Renal Stone Surgery.

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS. Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared. Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2; p = 0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9; p = 0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectively (p = 0.496). No major perioperative complications were seen. Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

The outcome of open renal stone surgery calls for limitation of its use: A single institution experience

ObjectivesTo critically analyze retrospectively the outcome of cases treated with open renal stone surgery (ORSS) at a single urology institution over a 7-year period. Subjects and methodsOut of 5172 stone-removal procedures performed at Al-Azhar University Hospitals, Cairo, Egypt, between January 2002 and December 2008, 533 cases (10.3%) underwent open surgery. The patients’ age ranged from 3 to 72 years (mean 41.7). The hospital charts, operative notes and pertinent radiographs of these 533 cases were revised to determine clinical data, stone burden, indications and operative and peri-operative outcome of surgery. The follow-up data covering a period of two years since the date of surgery were retrieved to study long-term results. ResultsThe indications for ORSS included complex stone burden (62.1%), failure of percutaneous nephrolithotomy (10.3%), large or multiple stones associated with calyceal diverticulum, ureteropelvic obstruction (5.8%) or ectopic and horse-shoe kidneys (3.4%). Additional indications were an abnormal body habitus, including an increased body mass index (BMI>35), and scoliosis (3.4%), concurrent open surgery (4.1%), and stones in non-functioning or infected kidneys (5%). 5.8% of the patients refused minimally invasive surgery and opted for ORSS.Operative complications, mainly in the form of primary or secondary hemorrhage, occurred in 186 (35%) patients. Salvage nephrectomy (secondary nephrectomy) was needed in two cases and mortality occurred in another two.Peri-operative (at 3 months) outcome, included significant residual fragments in 59 cases (11%) and deterioration of renal function in 92 (17.3%) cases. At discharge from the hospital, 76.2% of the patients were stone-free, while complete stone clearance was attained in a total of 89.1% at 3 months after additional auxiliary measures. ConclusionsAlthough nowadays, the treatment of choice for renal stones is minimally invasive, yet some cases still require open surgery. The high rate of surgical complications with ensuing compromised renal function and prolonged hospital stay are not in favor of ORSS. This option thus has to be limited to selected cases of complex stone burden, associated renal anomalies and after failure of minimally invasive surgery. The unavailability of minimally invasive equipment, lack of surgical experience and patient preference should not be taken as indication of ORSS.

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

The management of renal calculi following previous open surgery represents a challenge for urologists. The aim of this study is to evaluate the outcomes and safety of ureteroscopic laser retrograde intrarenal surgery (RIRS) for renal calculi following prior open renal surgery. The charts of 53 patients who underwent RIRS for renal calculi following prior open surgery for urolithiasis were reviewed. Both flexible and semi-rigid ureteroscopes were utilized together with holmium: YAG laser for stone disintegration. Intravenous urography, computed tomography (CT) and ultrasound were used to evaluate the patient, perioperatively. Stone size ranged from 5 to 32 mm (mean 14.3 mm). The mean operative time was 86 min (20-130). The overall stone-free rate was 92.4%. The overall stone-free rates after one and two-procedures were 79.2% (42 cases) and 92.4% (49 cases), respectively. Four patients (7.5%) had larger residual fragments, 2 (3.8%) of them underwent SWL, and 2 (3.8%) cases were followed up conservatively. Major complications were reported in two patients (3.8%). Stone analysis revealed calcium oxalate in 39 patients, uric acid in 5, calcium phosphate in 4, struvite in 3, and cystine in 2 cases. Ureteroscopic retrograde intrarenal surgery for renal calculi following prior open renal surgery was a minimally invasive, safe procedure with a high success rate. It is a viable alternative for PNL in managing recurrent renal calculi efficiently.