Retrograde Intrarenal Surgery Group Research Articles

RIRS with FV-UAS vs. ESWL for the management of 1-2 cm lower pole renal calculi in obese patients: a prospective study.

To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of 1-2 cm lower pole renal calculi (LPC) in obese patients. This prospective, randomized study included 149 obese patients with 1-2 cm LPC. Patients were allocated into two groups: 76 patients underwent RIRS with FV-UAS, and 73 patients received ESWL. The parameters assessed included stone-free rate (SFR), retreatment rate, complications, operative time, and pain intensity measured by the visual analog scale (VAS). Stone-free status was defined as the absence of stones on computed tomography or residual fragments smaller than 4 mm at 4 weeks post-procedure. The baseline characteristics of the two groups were comparable. The SFR was significantly higher in the RIRS group, reaching 86.8%, compared to 63.0% in the ESWL group (p = 0.034). Furthermore, the retreatment rate was significantly lower in the RIRS group, at 5.2%, versus 24.7% in the ESWL group (p < 0.001). The average operative time for RIRS was notably longer, at 65.3 ± 6.4 min, compared to 25.3 ± 7.8 min for ESWL (p < 0.001). The complication rates were 9.2% for the RIRS group and 6.8% for the ESWL group, with no statistically significant difference (p = 0.326). All complications were classified as Grade I or II according to the modified Clavien classification system. No significant differences were observed between the two groups regarding pain VAS scores and the composition of the stones. RIRS with FV-UAS demonstrated superior efficacy, evidenced by a higher SFR and reduced retreatment rates compared to ESWL, despite a longer operative duration. Both treatment modalities showed comparable safety profiles. RIRS with FV-UAS emerges as a viable, effective, and reproducible intervention for managing 1-2 cm LPC in obese patients, providing significant clinical advantages.

Does tilt-retrograde intrarenal surgery enhance stone clearance and offer better surgical ergonomics in patients with renal calculi? A prospective randomized control study

Introduction: Retrograde intrarenal surgery (RIRS) is the standard treatment for renal calculi. Direct visualization and fragmentation are its major advantages. The variable stone clearance rates and the ergonomic challenges faced by urologists are a few limitations. Table tilt enhances stone clearance and improves surgical ergonomics by facilitating better access to stones and reducing procedural strain. Subjects and Methods: In this prospective study, patients with intrarenal calculi were randomized into standard lithotomy RIRS (S-RIRS) and table-tilted RIRS (T-RIRS) groups. Specified table tilts were suggested for each of the stone locations. The outcomes with regard to stone clearance, operative and lasing time, and ergonomics were studied. Results: About 100 patients were studied, with 50 in each group. The overall operating time and lasing time in the T-RIRS group were less than that in the S-RIRS group (P &lt; 0.001). The complication rates were the same in both groups. Most surgeons felt that the surgical ergonomics was better in the T-RIRS group (P &lt; 0.001). When stone-free status was analyzed, seven patients in the S-RIRS group and one in the T-RIRS group had residual stones. The mean Borg category-ratio 10 (CR-10) scores in the S-RIRS and T-RIRS groups were 4.18 and 2.20, respectively (P &lt; 0.001). Conclusions: This is the first study to document the distinct advantages of T-RIRS and its benefits on surgical ergonomics. T-RIRS resulted in significantly shorter operative and lasing times, particularly for stones in lower calyces. Surgical ergonomics, assessed by the Borg CR-10 scale, were significantly better in the T-RIRS group. T-RIRS should become a standard of care for patients undergoing RIRS.

Comparison of two methods for treatment of 1-2cm kidney stones in pediatric patients: mini PCNL and RIRS.

This study aimed to compare the results of retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of 1-2cm kidney stones in pediatric patients. The records of patients under the age of 18 years who were diagnosed with unilateral 1-2cm kidney stones for the first time and underwent endoscopic surgery between February 2008 and April 2022 were retrospectively examined. The patients were divided into two groups: mini-PCNL and RIRS surgery. Parameters such as age, gender, number of stones, side, size and localization were examined. The main endpoint of the study was to compare stone-free rates (SFR) one month after both surgeries. Surgery and fluoroscopy times, postoperative hospital stay, hemoglobin decrease and complication rates were compared between the groups. SFR was evaluated one month after surgery by direct urinary system radiography and USG or CT. A total of 58 patients were included in the study. There were 35 patients in the mini-PCNL group and 23 patients in the RIRS group. Table1 shows the demographic and clinical characteristics of both groups. There was no significant difference between the groups in terms of age, gender, stone size, location, side and density. Calcium oxalate stones were observed at a higher rate in both groups. Mean fluoroscopy time was higher in the mini-PCNL group (p = 0.001). The mean surgery time was lower in the mini-PCNL group (p = 0.024). The mean hemoglobin decrease was greater in the percutaneous group (p = 0.039). There were no differences between the groups in terms of postoperative hospital stay, complication rates, and SFR one month after surgery. Although mini-PCNL seems to be more advantageous in terms of operation time compared to RIRS, it is disadvantageous in terms of average fluoroscopy time, radiation received and average hemoglobin decrease.

Residual Stone Fragments after Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery

Abstract Background Post-PCNL treatment for 0.5-1.5 cm calculi is contentious. SWL has noninvasiveness, less anaesthetic, and improved subjective acceptability, but a lower stone-free rate and higher retreatment rate (RR). Retrograde intrarenal surgery (RIRS) is increasingly employed to treat after PCNL residual calculi with a greater success rate (SR), but with disadvantages of invasiveness and anaesthesia. Aim To compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Subject and Methods A retrospective study of 70 adult patients with residual stone fragments after a standard PCNL submitted to RIRS or SWL (35 patients per each group) in ain shams university hospitals and police hospitals. Results There no significant difference between the groups regarding ASA, PCNL Guy’s classification, percutaneous tracts, stone composition and postoperative complications. There a significant difference between the groups regarding inferior calyx located stone and postoperative hospital stay. &amp;gt;2 mm stones were significantly more frequent in SWL group compared to RIRS group. Conclusion From the findings of this study we can conclude that RIRS has better SFR for the treatment of RSFs after standard PCNL

Comparison between mini-percutaneous nephrolithotomy and retrograde intra renal surgery for the management of lower calyceal calculi of size less than 1.5 cm : Our institutional experience

Background: The treatment of lower calyceal calculi with a size &lt;1.5 cm remains a subject of debate. Mini-percutaneous nephrolithotomy (Mini PCNL) and retrograde intrarenal surgery (RIRS) are both effective options, but there is a need for comparative analysis to determine the optimal approach. Mini-perc has the advantage of direct visualization and efficient fragmentation and clearance, while RIRS is a minimally invasive technique with excellent visualization and minimal morbidity. Aims and Objectives: This study aims to evaluate and compare the efficacy, safety, and outcomes of mini-perc PCNL and RIRS in the management of lower calyceal calculi. Materials and Methods: This retrospective comparative cohort study included a total of 72 patients with lower calyceal calculi &lt;1.5 cm. Thirty-six patients underwent mini-perc, and 36 patients underwent RIRS. Results: No significant differences were observed in patient demographic characteristics, stone size, or stone location between the mini-perc and RIRS groups. The mini-perc group had a significantly higher stone-free rate (SFR) (94.4%) compared to the RIRS group (86.1%) (P&lt;0.05). The mini-perc technique had a higher success rate in first-session stone clearance (88.9%) compared to RIRS (77.8%) (P&lt;0.05). The mini-perc group had a longer operative time, higher estimated blood loss, and a longer post-operative hospital stay compared to the RIRS group (P&lt;0.05). Conclusion: Both mini-perc and RIRS techniques are effective for managing lower calyceal calculi &lt;1.5 cm. Mini-perc offers a SFR and a better success rate in first-session stone clearance compared to RIRS. However, mini-perc procedures are associated with longer operative time, higher estimated blood loss, and a longer post-operative hospital stay.

Comparative study between retrograde intrarenal surgery and ultrasound- guided shock wave lithotripsy for treatment of 1 to 2 cm radiolucent lower calyceal stones.

The objective is to compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and ultrasound-guided (US-guided) shock wave lithotripsy (SWL) for the treatment of radiolucent lower pole calculi of 1-2 cm. This prospective randomized study was performed at our tertiary care urology institute of Benha University Hospitals; cases were randomized either to undergo RIRS (Group A) or US-guided SWL with a triple focus system (Group B). The safety and effectiveness of both therapies were compared using new criteria for stone-free rate (SFR): Grade A (absolutely stone free), Grade B (≤2 mm fragments), and Grade C (>2 mm up to 4 mm fragments), fluoroscopy time, operative time, auxiliary procedures, retreatment, and complications. Out of 100 patients, 92 were eligible for this study. RIRS had a higher SFR of 88.9% compared to SWL, 72.3% (P = 0.045). Furthermore, stone-free classification significantly differed between the studied groups (P < 0.001), with Grade A being significantly higher in Group A. Conversely, Grades B and C were lower in Group A. On the other hand, operative and fluoroscopy times were significantly reduced with SWL (P = 0.004 and < 0.001, respectively). While complications did not significantly differ between the two groups (P = 0.340), a significant distinction was observed in terms of the Clavien-Dindo classification. RIRS is an effective and safe option for treating radiolucent lower calyceal stones of ≤2 cm, with a greater SFR and lower need for auxiliary operations. However, Sono SWL is a cost-effective alternative that can achieve a comparable success rate after retreatment sessions.

Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1–2.5 cm) in children ≤10 years of age

With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5cm). Sixty pediatric patients with single or multiple renal stones (1-2.5cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86cm and 1.69cm for the PCNL group (P=0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P=0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.

Needle-perc-assisted endoscopic surgery versus retrograde intrarenal surgery for the treatment of 1- to 2-cm lower-pole renal stones in patients with unfavorable infundibulopelvic anatomy: a matched-pair analysis.

To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy. Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups. Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate.

Efficacy of Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Patients with Kidney Stones and Their Impact on Inflammatory Response and Renal Function.

Kidney stones are one of the most common benign diseases in urology. As technology updates and iterates, more minimally invasive and laparoscopic surgeries with higher safety performance appear. This paper explores the effectiveness of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in treating kidney stones, focusing on their effects on inflammatory responses and renal function. We conducted a retrospective analysis of 200 patients with kidney stones treated in our hospital between June 2019 and June 2023. 100 patients who underwent RIRS were included in the RIRS group. Another 100 patients who underwent PCNL treatment were included in the PCNL group. The intraoperative blood loss, operation duration, and hospitalization time of the two groups of patients were recorded and compared. The enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors in the serum of the two groups of patients: [serum amyloid A (SAA), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (CRP)] and renal function index [blood urea nitrogen (BUN), creatinine (Scr) and serum cystatin (Cys-c)]. The two groups of patients were recorded separately: Postoperative complications and stone-free rate. Operation duration was longer for the RIRS group than the PCNL group, which exhibited significantly less intraoperative blood loss and shorter hospital stays (p < 0.05). Before surgery, there was no statistically significant difference in the serum levels of SAA, IL-6, and CRP between the two groups of patients (p > 0.05). On the first day after surgery, the serum SAA levels in both groups were lower than before surgery, IL-6 and CRP levels were higher than before surgery, and the serum levels of SAA, IL-6, and CRP in the RIRS group were significantly lower than those in the PCNL group. The difference was statistically significant (p < 0.05). Before surgery, there was no statistically significant difference in the serum BUN, Scr, and Cys-c levels between the two groups of patients (p > 0.05). On the first day after surgery, the serum BUN, Scr, and Cys-c levels of the two groups of patients were significantly higher than those before surgery. The serum BUN, Scr, and Cys-c levels of the RIRS group were significantly lower than those of the PCNL group, and the difference was statistically significant (p < 0.05). Both surgical methods have sound stone-clearing effects regarding long-term stone clearance rates 1 month and 3 months after surgery (p > 0.05). PCNL had a better stone clearance rate on the 2nd postoperative day (p < 0.05). The incidence of postoperative complications in the RIRS group was significantly lower than that in the PCNL group, and the difference was statistically significant (p < 0.05). For kidney stones ≤2 cm, PCNL showed higher stone clearance rates on the second postoperative day. However, RIRS and PCNL demonstrated adequate long-term stone clearance at 1 and 3 months post-surgery. Both surgical methods are safe and effective, and RIRS is safer than PCNL. Compared with PCNL, RIRS is a new method of kidney stone operation, which has less trauma to the patient's body and fewer complications after the operation, speeding up the recovery process of the patient.

A Comparative Study of Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for the Management of Staghorn Renal Calculi.

The indications for performing retrograde intrarenal surgery (RIRS) have increased. However, no comparative studies have been conducted on the treatment of staghorn renal calculi using RIRS and percutaneous nephrolithotomy (PCNL). We aimed to compare the effectiveness and safety of RIRS and PCNL as treatments for staghorn renal calculi. We conducted a retrospective analysis of patients with staghorn renal calculi who underwent either PCNL or RIRS at our hospital from January 2021 to July 2023. Patients with staghorn renal calculi and renal malformation, as well as those with interrupted treatment or irregular follow-up, were excluded from the study. We compared the perioperative outcomes and complications between the groups. Fifty patients were included in the RIRS group, whereas 48 patients were included in the PCNL group. 1. No significant differences were observed between the groups regarding the number of complete staghorn calculi, stone size, age, sex, or other demographic characteristics. 2. RIRS was associated with a shorter postoperative hospitalization time (2.14 ± 0.76 vs. 5.15 ± 1.98 days, p < 0.001). 3. RIRS was associated with a decrease in hemoglobin (0.1 [0, 0.2] vs. 0.65 [0.4, 1] g/dL, p < 0.001) and a lower pain score (1 [1, 2] vs. 2 [1, 3], p = 0.008). 4. Compared with PCNL, RIRS did not significantly differ in terms of the 1-stage stone-free rate (50% vs. 66.67%, p = 0.095) or total stone-free rate (84% vs. 89.58%, p = 0.415). 5. The overall complication rate was lower in the RIRS group (10% vs. 16.67%, p = 0.331). Compared with PCNL, RIRS can reduce bleeding and overall complications, shorten the hospitalization time, and achieve satisfactory stone-free rate. As a result, RIRS can be considered an alternative treatment option for staghorn renal calculi.

Comparison of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for 1-2 cm renal stones: A single-center experience.

Background: The management of renal stones has undergone significant advancements in recent years, with percutaneous nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) emerging as minimally invasive alternatives to traditional Pyelolithotomy. This study aims to assess the effectiveness of Mini-PCNL and RIRS for renal stones measuring 1-2 cm, focusing on operative time, stone clearance, hospital stay, and the need for ancillary procedures. Methodology: This retrospective study collected data from the medical records of patients admitted to The Department of Urology at The Kidney Centre, Karachi, between January 1, 2021, and August 31, 2022. The study included 100 patients who underwent RIRS and 129 patients who underwent Mini-PCNL. Results: It was found that the operative time was statistically similar in both groups. However, the length of hospital stay was significantly higher in the Mini-PCNL group (more than 2 days in 88.4%), whereas in the RIRS group, the majority of patients stayed ≤ 2 days (78%). Overall stone clearance was 82.1%, with a slightly higher clearance rate in patients who underwent Mini-PCNL (85.3%) compared to RIRS (78%), though the p-value was not statistically significant. Conclusion: For renal stones sized 1-2 cm, both RIRS and Mini-PCNL demonstrate efficient treatment options with comparable stone-free rates. RIRS appears more comfortable and less morbid than Mini-PCNL, with a shorter hospital stay. Although Mini-PCNL requires an extended hospital stay to treat 1- to 2-cm renal stones, it is associated with fewer complications and a reduced need for a JJ stent, making it a viable alternative to RIRS in certain cases.

Frequency of Metabolic Syndrome in Patients with Type 2 Diabetes Mellitus

Background: The management of renal stones has undergone significant advancements in recent years, with percutaneous nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) emerging as minimally invasive alternatives to traditional Pyelolithotomy. This study aims to assess the effectiveness of Mini-PCNL and RIRS for renal stones measuring 1-2 cm, focusing on operative time, stone clearance, hospital stay, and the need for ancillary procedures. Methodology: This retrospective study collected data from the medical records of patients admitted to The Department of Urology at The Kidney Centre, Karachi, between January 1, 2021, and August 31, 2022. The study included 100 patients who underwent RIRS and 129 patients who underwent Mini-PCNL. Results: It was found that the operative time was statistically similar in both groups. However, the length of hospital stay was significantly higher in the Mini-PCNL group (more than 2 days in 88.4%), whereas in the RIRS group, the majority of patients stayed ≤ 2 days (78%). Overall stone clearance was 82.1%, with a slightly higher clearance rate in patients who underwent Mini-PCNL (85.3%) compared to RIRS (78%), though the p- value was not statistically significant. Conclusion: For renal stones sized 1-2 cm, both RIRS and Mini-PCNL demonstrate efficient treatment options with comparable stone-free rates. RIRS appears more comfortable and less morbid than Mini-PCNL, with a shorter hospital stay. Although Mini-PCNL requires an extended hospital stay to treat 1- to 2-cm renal stones, it is associated with fewer complications and a reduced need for a JJ stent, making it a viable alternative to RIRS in certain cases.

Mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of 10-20-mm kidney stones in patients with ileal conduit: a comparative study.

Both mini-percutaneous nephrolithotomy (mPNL) and retrograde intrarenal surgery (RIRS) are two major strategies for the endourological management of kidney stones. In the current study, we aimed to compare the efficacy and safety of mPNL and RIRS for the treatment of 10-20 mm kidney stones in patients with ileal conduit. Patients with a history of bladder cancer and ileal conduit who had undergone mPNL or RIRS for unilateral kidney stones 10-20 mm in size between January 2015 and June 2022 were retrospectively included. Baseline characteristics and perioperative outcomes were analyzed and compared between mPNL and RIRS. The failure rate of the initial surgery was 2.5% and 18.9% for mPNL and RIRS, respectively (P=0.025). In total, 39 and 30 patients were finally included in the mPNL and RIRS groups. One-session stone-free rate (SFR) was higher in the mPNL group than the RIRS group (97.4% vs. 66.7%, P=0.002). However, there was no statistically significant difference between the two groups with regard to operation time, postoperative hospitalization, complications according to Clavien-Dindo classification, as well as the change in hemoglobin, creatinine, procalcitonin, and pain Visual Analogue Scale Score before and after the surgery. Moreover, Results were consistent across subgroup analyses in patients stratified by years (2015-2018 and 2019-2022). Both mPNL and RIRS were feasible and safe for the treatment of 10-20 mm kidney stones in patients with ileal conduit. However, mPNL achieved superior SFR outcomes with a similar incidence of complications, and it might be a sensible alternative for selected patients.

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.

Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment

The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). The study highlighted the positive effect of the one-day surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Minimally invasive nephrolithotomy versus retrograde intrarenal surgery in surgical management of Lower calyceal stones: A systematic review with meta-analysis.

The efficacy and safety of minimally invasive nephrolithotomy (MPCNL) versus retrograde intrarenal surgery (RIRS) was assessed for lower calyceal (LC) stones. Our team conducted a systematic literature search up to December, 2022, using PUBMED, EMBASE and the Cochrane Library. The study was registered in PROSPERO, CRD 42021247197. Randomized controlled trials evaluating the efficacy and safety of MPCNL versus RIRS for LC stones were collected. Heterogeneity among the studies was assessed using the χ2 test based on the Q and I2 tests. Pooled effect sizes were calculated using a fixed model if I2 < 50%; otherwise, a random-effects model was chosen. The primary outcomes were the 3-month stone-free rate (3SFR) and total complications, while the secondary outcomes were the operating time, hospital stay, hemoglobin reduction, bleeding, postoperative fever and complications with the Clavien-Dindo system. A subgroup analysis of 10-20mm LC stones was also designed. A total of 7 peer-reviewed trials comprising 711 patients were identified. No statistical differences were observed in the heterogeneity results of the 3SFR or total complications (P>0.1, I2 < 50%). Compared with RIRS, MPCNL had an unfavorable safety profile, resulting in total complications (OR: 1.87 [95%CI: 1.05, 3.33]; P=0.03), hemoglobin reduction (OR: 0.81 [95%CI: 0.15, 1.47]; P=0.02) and complications with Grade I (OR: 5.52 [95%CI: 1.34, 22.83]; P=0.02) but an improved efficacy and 3SFR (OR: 2.43 [95%CI: 1.48, 3.97]; P=0.0004). As for the 10-20mm LC stones, compared with RIRS, MPCNL also had an unfavorable safety profile, resulting in total complications (OR: 2.47 [95%CI: 1.20, 5.07]; P=0.01), complications with Grade I (OR: 4.97 [95%CI: 0.99, 25.01]; P=0.05) and an increased hospital stay (OR: 2.46 [95%CI: 2.26, 2.66]; P=0.00001) but an improved efficacy and 3SFR (OR: 3.10 [95%CI: 1.61, 5.99]; P=0.0008). The efficacy effect of MPCNL and safety effect of RIRS were nearly equal for both stones sized < 20mm (NNT = 17, NNH = 20) and stones sized 10-20mm (NNT = 20, NNH = 13). No statistical difference was found between the MPCNL and RIRS groups for the rest of outcomes. Both MPCNL and RIRS are safe and effective management methods. Moreover, compared with RIRS, MPCNL had an unfavorable safety profile but improved efficacy for LC stones of ≤20mm or 10-20mm, and the differences were statistically significant. The relative profit of efficacy of MPCNL was similar to the relative profit of safety of RIRS.

A Newly Developed Hematuria Grading System May Predict the Status of Stone-Free and Acute Pyelonephritis of Minimally Invasive Renal Stone Surgery.

The aim of this study was to evaluate the level of hematuria and the presence of clots during retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) to predict surgical outcomes. The data of patients who underwent RIRS and mPCNL were analyzed separately. A hematuria grading (HG) system was classified into five grades based on the presence of blood clots and any visible stones according to the irrigation settings. Inter-observer reliability of the grading system was assessed using intra-class correlation and Spearman's rho. The HG system showed high agreement among examiners, with high intra-class reliability and a strong correlation between RIRS and mPCNL groups. The stone density of the Houns-field unit was the most important factor in determining the hematuria across the development and validation groups of RIRS and mPCNL patients. Multivariate logistic regression analysis showed that the HG system was a significant predictor for remnant stones in the PCNL group and the probability of acute pyelonephritis or sepsis in the RIRS group. The high hematuria group showed lower basketing difficulty with the basket with a blue marker instrument than with others. The new HG system shows excellent inter-observer reliability and a correlation with a gradual increase in stone density and surgical difficulty.

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%).

Comparison of stone-free rate between percutaneous nephrolithotomy and retrograde intrarenal surgery.

The management of urolithiasis in the kidney has been drastically changed in the era of endourology, mainly consisting of three surgical procedures: extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). Since ESWL is usually less invasive via ambulatory clinic routes, this study aimed to examine the stone-free rate (SFR) between PCNL and RIRS. We retrospectively reviewed patients who had renal stones and were treated with either PCNL or RIRS from June 2016 to June 2018. Staghorn stones, stones with diameters <1 cm, and stones with diameters >2 cm were excluded. Patients who underwent multiple surgeries for bilateral renal stones and those with graft kidney stones were excluded from the study. X-ray, sonography, and/or computed tomography (CT) were used to calculate the size of the stones. Follow-up was evaluated by the same image examination within three months after surgery. Stone-free was defined as no residual stone or the presence of asymptomatic calculi <4 mm. The operation time was defined as a skin-to-skin interval. Following exclusion criteria, there were 39 patients in each arm, with no difference in age, sex, or any other demographic data. The average stone size in the PCNL and RIRS groups was 16.3 and 14.0 mm, respectively ( p = 0.009). There was no significant difference in SFR (71.8% vs 61.5%, p = 0.337); the operation time was significant longer ( p < 0.001), and the hospital stay was significantly shorter ( p < 0.001) in the RIRS group. PCNL and RIRS are both feasible options for managing kidney stones. However, the initial stone size might affect the selection of operation. The SFR in the PCNL group was numerically but not statistically higher. The RIRS group, on the other hand, had a longer operation time but a shorter hospital stays.

What Is the Ideal Treatment for 20-30 mm Kidney Stones? Comparative Outcomes of 1197 Patients.

Background: The purpose of this study is to compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), mini-percutaneous nephrolithotomy (mPNL), and standard-percutaneous nephrolithotomy (stPNL) for the treatment of 20-30 mm kidney stones. Methods: The records of 1197 patients (SWL = 149, RIRS = 205, mPNL = 525, and stPNL = 318) from 8 centers were reviewed retrospectively. Four procedures were compared for stone-free rates (SFRs), auxiliary treatment, and associated complications. Results: Initial SFRs were 43.6%, 54.6%, 86.7%, and 87.7% in SWL, RIRS, mPNL, and stPNL, respectively (P < .001), whereas the final SFRs were 71.8%, 80%, 90.5%, and 89.6% (P < .001). The rate of auxiliary treatment in the groups was 38.3%, 26.8%, 5%, and 4.4%, respectively (P < .001). The initial and final SFRs in the mPNL and stPNL groups were higher than those in SWL and RIRS groups (P < .001). The rate for auxiliary treatment was lower in the mPNL and stPNL groups (P < .001). The operation time was longer in the RIRS group (P = .005). According to the Clavien-Dindo classification, the complication rate in the SWL group was lower than that in the surgical approaches (P < .001); however, no statistical difference was detected between RIRS, mPNL, and stPNL groups. mPNL and stPNL had a higher success rate than RIRS or SWL for treating 20-30 mm kidney stones. Conclusion: In the treatment of 2-3 cm renal stones, RIRS and PNL were more effective than SWL to obtain a better SFR and less auxiliary treatment rate. Compared with RIRS, mPNL and stPNL provided a higher SFR with similar complication rates.