Outcomes Of Retrograde Intrarenal Surgery Research Articles

The Effect of Ureteral Access Sheath Use/Caliber Change on Outcomes of Retrograde Intrarenal Surgery, Short-Term Kidney Functions, Radiation Exposure, Ureteroscope Lifetime, and Factors Predicting Insertion Failure: A RIRSearch Study.

Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients (n = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P < .001). Fluroscopy times were 5, 15, and 87 sn, respectively (P < .001). Short URS-LT was strongly associated with high frequency of lower calix stones (r = -0.94, P = .005), but URS-LT was not correlated with sheathless case rate (r = 0.59, P = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P = .03), hydronephrotic (OR: 3.4, P < .001), and female cases (OR: 1.5, P = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.

Üreteral giriş kılıfı ve floroskopi kullanılarak yapılan retrograd intrarenal cerrahinin karşılaştırmalı değerlendirilmesi: böbrek taşı tedavisinde retrospektif bir analiz

Aims: This study aimed to investigate the outcomes of retrograde intrarenal surgery (RIRS) with and without the utilization of ureteral access sheath (UAS) and fluoroscopy for treating kidney stones and its implications on postoperative complications.&#x0D; Methods: Employing a retrospective design, we analyzed the records of 314 patients subjected to RIRS due to kidney stones. Patients were categorized into two groups based on the application of fluoroscopy and UAS (Group 1) versus non-application (Group 2). Various metrics, including stone-free rates, residual stone rates, and postoperative complications, were compared between the groups.&#x0D; Results: The results showed no significant differences between the two groups regarding patient age, stone size, and several demographic parameters. However, there was a considerable reduction in operation duration in Group 2 (20.96±5.97 minutes) compared to Group 1 (26.15±5.41 minutes), where UAS and fluoroscopy were applied, with p=0.001. Furthermore, post-treatment results highlighted a decline in residual stone rates and an enhancement in stone-free rates, though differences between groups were not significant. The incidence of postoperative complications, like fever, urinary tract infections, and ureteral stenosis, was assessed, revealing no differences between the two groups.&#x0D; Conclusion: The application of RIRS without UAS and fluoroscopy appears to be a promising approach to treating kidney stones, offering similar outcomes regarding stone removal efficacy and postoperative complications compared to the traditional method with UAS and fluoroscopy. This research emphasizes the potential of a less invasive method, warranting further studies to understand its broad implications.

COMPARISON OF RETROGRADE INTRARENAL SURGERY OUTCOME VERSUS PERCUTANEOUS NEPHROLITHOTOMY IN RENAL STONES &gt;2 CM IN DIAMETER IN LOWER CALYCES AT A TERTIARY CARE HOSPITAL

This study aimed to compare the outcome of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy in treating renal stones larger than 2 cm in diameter in lower calyces at a tertiary care hospital. A randomized control trial was conducted at the Department of Urology, Bahawal Victoria Hospital, Bahawalpur, for 8 months from 01-06-2021 to 01-02-2022 using a non-probability purposive sampling technique. Seventy patients met the inclusion and exclusion criteria and were enrolled in the study. The patients were randomly divided into two groups using a lottery method. Group A underwent PCNL, while Group B underwent RIRS. During the procedure, the operative time was noted from the time of intubation to the time of extubation. After the procedure, the duration of hospital stay was noted, and the patients were followed up in the OPD for 12 weeks. After 12 weeks, an abdominal ultrasound was conducted to evaluate if there were any residual stones. If there were no residual stones, the patients were labeled stone-free. Seventy patients participated in the study, with a mean age of 45.51±13.68 years, ranging from 20 to 69 years. The mean age of patients in the RIRS group was 47.63 ± 13.51 years, while in the PCNL group, it was 43.40 ± 13.71 years, with a non-significant p-value of 0.198. The gender distribution among the patients revealed that 30 (42.86%) were male and 40 (57.14%) were female, with an equal distribution of males (15, 42.9%) in both the RIRS and PCNL groups. However, there were substantial differences in the duration of surgery, with the RIRS group having a mean operative time of 107.57 ± 6.99 minutes and the PCNL group having a significantly shorter mean operative time of 75.86 ± 7.19 minutes (p-value &lt; 0.001). Moreover, the RIRS group had a shorter mean hospital stay, with 4.77 ± 1.03 days compared to 5.46 ± 1.09 days in the PCNL group (p-value = 0.009). Post-procedure, 63 (90%) patients achieved stone-free status, with 29 (82.9%) patients in the RIRS group and 34 (97.1%) in the PCNL group, with a non-significant p-value of 0.106. This study concluded that RIRS is a safe procedure and a good alternative to PCNL in treating renal stones larger than 2 cm in diameter in lower calyces to achieve stone-free status and length of hospital stay.

Does age impact outcomes of retrograde intrarenal surgery in the elderly? Results from 366 patients from the FLEXible ureteroscopy outcomes registry (FLEXOR)

BackgroundThere has been a consistent increase in the last decades in prevalence of renal stones in elderly.AimsTo evaluate outcomes of retrograde intrarenal surgery (RIRS) for renal stones in elderly and factors associated with postoperative complications and residual fragments (RFs).MethodsData from 12 centers were retrospectively reviewed. Inclusion criteria: ≥ 75 years, renal stones only, normal renal anatomy. Patients were divided into three groups; Group 1: patients aged 75–79 years; Group 2: age 80–84 years; Group 3: age ≥ 85 years. Multivariable logistic regression analyses were performed to assess factors associated with perioperative complications, sepsis, and RFs.Results366 patients were included. There were 189 patients in Group 1, 113 in Group 2, and 64 in Group 3. There was no difference between groups regarding stone features and total surgical time. Median length of stay was significantly longer in Group 3 (6.0 days, vs 2.0 days in Group 2 vs 2.5 days in Group 1, p = 0.043). There was no significant difference in postoperative complications and RFs between the groups. At multivariable logistic regression analysis, female gender (OR 2.82) and maximum stone diameter (OR 1.14) were associated with higher odds of sepsis, while surgical time (OR 1.12) and the use of a reusable ureteroscope (OR 6.51) with overall complications. Stone size (OR 1.23) was associated with higher odds of RFs.ConclusionRIRS showed safety and efficacy for kidney stones in elderly patients. Surgical time should be kept as short as possible to avoid higher odds of postoperative complications, particularly in females.

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm.

Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.

Is It a Good Strategy to Proceed a Retrograde Intrarenal Surgery Session Sheathless After Ureteral Access Sheath Insertion Failure? A RIRSearch Study.

Objectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless (n = 110, Group 1) and those who proceeded without UAS after insertion failure (n = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS (p = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) (p = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p = 0.001). Stone burden (odds ratio [OR]: 1.002, p = 0.019) and stone density (OR: 1.002, p = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases.

The Feasibility and Outcomes of Retrograde Intrarenal Surgery to Treat Staghorn Renal Calculi

Objective: To study the safety and efficacy of retrograde intrarenal surgery (RIRS) in patients with staghorn stones. Materials and Methods: This retrospective observational study was carried out between May 2016 and October 2020, which is when we performed RIRS in staghorn stone patients. Medical records of all patients with this condition in the database of Siriraj Hospital were reviewed. A total of 35 patients were eligible for this study. Descriptive statistics were used to assess the safety and efficacy of RIRS in patients with staghorn stones. Results: In total, 31.43% of patients were stone-free after the first round of RIRS and 59.55% achieved stone-free status after the second procedure. The stone-free rate did not increase after a second round of RIRS. The median size of all staghorn stones was 3.1 cm. Unfortunately, we found two sepsis patients in this study. We also found eight events of minor complications, including fever and minimal ureteric injury in 54 sessions of RIRS we performed. However, no major injuries or bleeding requiring blood transfusion was identified. Conclusion: Percutaneous nephrolithotomy (PCNL) is still considered the first-line therapy for kidney stones over two centimeters with a favorable stone-free rate. But, in some patients with limitations such as uncorrectable coagulopathies, impaired renal function, single kidney, and morbid obesity, RIRS is a good choice to reduce the likelihood of serious complications and have an acceptable stone-free rate. However, a prospective study should be performed to confirm these findings.

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%).

Effect of ureteric access sheath on outcomes of retrograde intrarenal surgery for renal stone disease: a randomized controlled trial

The need of ureteric access sheath (UAS) in retrograde intrarenal surgery (RIRS) has been controversial for gaining high success in terms of stone free rate (SFR), reducing operative times and complications. There has been lack of high level of evidence in the literature on this topic. This prospective randomized controlled trial (RCT) was conducted in the Department of Urology, PGIMER, Chandigarh from July 2019 to Dec 2021. The effect of UAS on the outcome of RIRS (SFR, operative time and complications) for renal stone disease was assessed. Ninety patients were randomized into two groups: 41 patients in Group 1 (RIRS with UAS) and 40 patients in Group 2(RIRS without UAS) were finally analyzed after exclusion. All the patients underwent preoperative double J stent placement at least 10days prior to the definitive procedure. Operative time was recorded and postoperative pain was assessed by visual analogue scale(VAS) at 6 and 24h postoperatively. Complications and emergency visits were recorded up to one month post procedure. SFR was assessed at 1month using noncontrast CT KUB. Success was defined as absence of any residual fragment more than 3mm in maximum diameter. Demographic parameters (age, body mass index, and comorbidities) and preoperative parameters (stone burden, proportion of recurrent stone formers and proportion of patients with inferior calyceal stones) were comparable between the two groups. Operative times (45.49 vs 48.38min; p - 0.484) and VAS scores at 6 and 24h post-op (p - 0.577) were also comparable between Group 1 and Group 2. SFR was comparable in Group 1 and Group 2 (78.05% vs 80%, p - 0.829). Postoperative complications were higher in the UAS group, but not statistically significant (4.88% vs 0%; p - 0.157). The use of UAS during RIRS is not associated with improved SFR. RIRS can be performed safely without the use of UAS and without increasing postoperative complications.

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.

Role of Preoperative Ureteral Stent on Outcomes of Retrograde Intra-Renal Surgery (RIRS) in Children. Results From a Comparative, Large, Multicenter Series

To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones. Children/adolescent with kidney stones undergoing RIRS in 9 centers between 2015 and 2020 were retrospectively reviewed. ureteral lithotripsy, bilateral procedures. Stone-free status was evaluated at 3-month and defined as a single residual fragment (RF) ≤2 mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no-prestenting; Group 2 prestenting). Student's, Chi-square and Fisher's exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical significance: P-value <0.05. Three hundred eighty-nine children/adolescents were included (192 patients in Group 1). Prestented patients were younger compared with non-prestented (mean age 8.30 ± 4.93 vs 10.43 ± 4.30 years, P < 0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, P=0.016). Sepsis occurred in 2.1% of patients in Group 2 and no patient in Group 1 (P=0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (P=0.322). In univariate logistic regression analysis, stone size was associated with RF (OR 1.12 95%CI 1.06-1.18, P < 0.001), whereas Thulium fiber laser with a lower incidence (OR 0.24 95%CI 0.06-0.69, p=0.020). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95%CI 1.08-1.36, P=0.001). RIRS showed similar stone-free rate in pre and non-prestented children/adolescents, although prestented patients were younger. A higher risk of post-operative infections was reported in prestented patients.

Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones.

Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0–28.8) vs. 13.0 (11.8–15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0–100) minutes] as compared to the SUAS group [47.5 (41.5–60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667–1.00) vs. 1.00 (1.00–2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.

The effect of Trendelenburg position on outcomes of retrograde intrarenal surgery for medium sized renal pelvis stones

Aim: To compare safety and efficiency between Trendelenburg position retrograde intrarenal surgery (tRIRS) and conventional position retrograde intrarenal surgery (cRIRS) in the management of renal pelvis stones 10-20 mm in size. &#x0D; Material and Method: From September 2018 to September 2019, the patients undergoing RIRS for single renal stones between 10-20 mm were included in the study prospectively. Patients were divided into two groups randomly. First group of patients were positioned completely parallel to the ground (cRIRS), second group were positioned with Trendelenburg (tRIRS). Success was evaluated at end of 3rd months by non-contrast enhanced tomography. Stones that smaller than 4 mm were accepted as clinical insignificant residual fragment. Complications was classified according to Clavien, class 2 or more complications were recorded. &#x0D; Results: Totally 100 patients were included to final analyze. Patients’ age, gender, stone side and mean stone surface area were similar between groups. Success rate was higher in tRIRS group (90% vs 72% p=0.022). Mean operation time was lower (41.8 vs 58.2 min. p

Outcome of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy in the Treatment of Upper Calyceal Stone of ≥2 cm in Diameter

Back ground: The incidence of renal calculi is rising and more patients are presenting with small renal calculi. The treatment options for renal calculi (d”2 cm) are ESWL, percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The development of minimal invasive surgery for the treatment of renal calculus has led to an increase in success rates and, at the same time, has decreased the morbidity associated with these treatments. Objective: The study aimed to evaluate outcome of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy in the treatment of upper calyceal stone of d”2 cm in diameter. Methods: 60 Patients with radiopaque upper calyceal stone (d”2 cm) were admitted and underwent RIRS (Group A) &amp; PCNL (Group B) in Urology department as per inclusion and exclusion criteria by purposive sampling (30 patients in each group). Complete clinical evaluation including history, physical examination, relevant examinations &amp; laboratory investigations were performed. Result: Mean age was 37.23±11.59 years (range 18-62years) in group A and 40.10±11.49 (range 18-65 years) in group B. Mean operative time was significantly lower in group A (90.13 +/- 18.79 min) than group B (107.36 +/- 16.4 min) (p &lt;0.05). Mean volume of irrigation fluid used during surgery, mean drop in the postoperative hemoglobin concentration, hospital stay, mean VAS score at 8 hours &amp; 24 hours after operation were significantly lower in RIRS group than PCNL group (p&lt; 0.05). We achieved a stone clearance of 90.00% in the RIRS group and 96.67% in the PCNL group. The difference in stone clearance in two groups was not statistically significant (p=0.30). Conclusion: The study concluded Retrograde intrarenal surgery (RIRS) in the treatment of upper calyceal stone of d”2cm in diameter is a feasible, effective and safe treatment option. Given the added morbidity in PCNL, RIRS should be considered standard therapy in these patients. Bangladesh J. Urol. 2021; 24(1): 99-104

Outcomes of Retrograde Intrarenal Surgery in Renal Calculi of Varying Size

The patient with the large renal calculi is recommended with retrograde intrarenal surgery by the physicians. It is minimally invasive approach for the treatment. Objective: The study was conducted for evaluation of the intraoperative and postoperative complications associated with the retrograde intrarenal surgery RIRS. The stone free rate rates were also compared. Methods: The 231 patients who visited the Urology department of our teaching hospital were included in the study. The duration of this study was from January 2021 to June 2021. The patients were divided into six groups. The calculi of dimension 1-9 mm were included in the group 1, while 10-19 mm were included in the group 2, 20-29 mm were included in group 3. The calculi of dimension 30-39 mm were included in group 4, the calculi of dimension 40-49 mm in group 5, while calculi greater than 50mm dimension were included in the group 6. The post-operative complications were reported while six-month follow months. Results: Out of the 231 patients included in the study. According to the study smallest size of calculi observed to be 3 mm and the largest size of calculi was found to be 60 mm. The average size of the calculi came out to be 22.9 ± 11.2 mm. The adverse events were observed in different groups. 11% of the patients reported some intraoperative negative effects. There were 31 patients that showed post procedure complications but these complications were later on found to be gone leaving no adverse side effect. 10% patients that undergo repetitive RIRS to clear the stones and were later-on confirmed stone free. Conclusion: For the treatment and management of the renal stones that are more than 20 mm in size RIRS is an encouraging option. There was a size dependent enhancement in the complications that take place after the procedure. There was no case of stone related events reported in patients that took care of follow up sessions to get rid of residual stones.

Outcome of retrograde intrarenal surgery in the management of urolithiasis in a tertiary care centre in North India

Background: Nephrolithiasis is the most common presenting pathology to the urology clinic. Retrograde intrarenal surgery (RIRS) has made the treatment of upper ureteral and renal calculi a relatively atraumatic affair. We undertook a study to analyse the outcomes of RIRS performed at our institute.Methods: All patients undergoing RIRS at Government Medical College and Associated Hospitals, Jammu from November 2015 to October 2016 were included in the study population and the data prospectively collected. Patients were followed up till 6 months.Results: 62 patients underwent the procedure during the study period. Majority of the patients were of the younger age group with 56.45% patients being females. 41.9% (n=26) patients had ureteric calculi which were pushed back while 12.9% (n=8) patients had concurrent ureteral and renal calculi. One patient had a malrotated kidney with calculus, which could be cleared. The median stone size was 12 mm (range 7-18 mm). 87% were stone free at the end of the procedure. 6% procedures had to be abandoned, and 6% patients underwent follow on extracorporeal shock wave lithotripsy (ESWL). The overall stone free rate was 93.54%. The mean post-operative pain score was 2.8. Five patients developed post-operative pyelonephritis and none developed ureteric injury, avulsion or collection. At 6 months, no patient had stone recurrence or hydronephrosis.Conclusions: RIRS is a relatively safe procedure with good stone clearance. Minimal post-operative pain, with &gt;90% stone clearance make it the cornerstone in the management of renal calculi. Our study shows that RIRS can be safely performed with minimal long term complications.

Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts.

To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1mm and < 4mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4mm but not for SFR < 1mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.

Prospective study on Comparison of outcomes of mini percutaneous nephrolithotomy versus retrograde intrarenal surgery for renal stones of 1-2 cm size.

Aim and Objectives:The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate.Materials and Methods:This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi.Inclusion criteria: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020Age >15 years. Exclusion criteria: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal systemPregnant women. Results:The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance.Conclusion:The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups.

Outcomes of retrograde intrarenal surgery in renal calculi of varying size.

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 (P = 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 (P = 0.024). The final SFRs were 95.2%, 100%, 96.6%, 90.9%, 86.7% and 71.4% in groups 1–6, respectively (P = 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.

Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes?

ABSTRACTPurpose:The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS).Materials and Methods:Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded.Results:Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p <0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198).Conclusions:Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.