Safety Of Retrograde Intrarenal Surgery Research Articles

Do we have a limit for retrograde intrarenal surgery for solitary kidney stone?

The management of urolithiasis in patients with a solitary kidney is challenging for urologists. This study aimed to evaluate the safety of retrograde intrarenal surgery (RIRS) in the treatment of stones in patients with solitary kidney and to reply to the question if there is any limit for this surgery. Between January 2016 and December 2019, we enrolled 52 patients who had a solitary kidney and underwent RIRS. We collected data on preoperative patient characteristics, stone dimensions, and postoperative outcomes. Stone size, duration of operation, duration of fluoroscopy, type of anesthesia, and degree of surgical complication were evaluated retrospectively. Surgeries performed in less and more than 60 minutes and with and without complications were compared. A total of 52 patients with a kidney stone and a solitary kidney were evaluated. The mean stone size was 14 ± 0.4 cm and surgical success rate was 87.3%. In our study, 13 patients (24.5%) had grade 1 minor complications, and none required a blood transfusion. The mean operation time was 51.9 ± 17.3 minutes. The postoperative creatinine value increased in 6 patients. The duration of operation in the group with complications was significantly higher than that in the group without complications. In patients who underwent an operation lasting ≥ 60 minutes, stone size, fluoroscopy time, and complication rate were significantly higher than in patients who underwent an operation lasting ≤ 60 minutes. Our opinion is to be careful in patients with a solitary kidney with a big stone and we recommend assigning these procedure to experienced hands for not exceeding 60 minutes in one session.

Is Retrograde Intrarenal Surgery as Safe for Children as It Is for Adults?

Introduction: The primary aim of this study is to compare the efficacy and safety of retrograde intrarenal surgery (RIRS) among the children and adults with similar stone burdens and locations. Also, the secondary aim of this study is to identify the factors affecting the stone-free rates (SFRs) of RIRS. Methods: We retrospectively compared perioperative results, SFRs, and complication rates (CRs) between pediatric (group 1, n: 55) and adult (group 2, n: 220) age groups diagnosed with kidney stones and treated by flexible ureterorenoscopy using the same instruments. Furthermore, multivariate analysis was performed to determine the factors affecting the SFR. Results: A total of 275 patients (pediatric group: 55; adult group: 220) were included in this study. The mean age of pediatric and adult groups was 7.2 ± 5.3 and 43.9 ± 15.1, respectively. The mean stone size was 13.9 ± 6.6 mm in the pediatric group compared to 14.8 ± 6.7 mm in the adult group (p = 0.35). Stone localizations and number were similar. JJ stenting for passive dilatation and use of UAS were higher in the pediatric group (p = 0.002; p = 0.017). However, postoperative double pigtail stenting rate was higher in the adult group (p < 0.001). Total CR was 13.8% and mostly Clavien I–II, and no difference was observed between the 2 groups (p = 0.541). The SFRs between the groups were similar (pediatric group: 81.8%; adult group: 78.2%; p = 0.554). On multivariate analysis, stone size (p < 0.001) and lower calyx stone (p < 0.001) were the negative predictive factors for SFR. Conclusion: There are small technical differences between pediatric patients and adult patients in our study, but RIRS in children is as safe and efficient as it is in adults.

Vücut kitle endeksi ile retrograd intrarenal cerrahi sonuçları arasındaki ilişki

Objective: Overweight and obesity increased worldwide over four decades. In 2016, nearly 11% of men and 15% of women over 18 years old were obese. Obesity is accepted as a risk factor for renal stones. The relationship between obesity and urolithiasis is complicated. Various complications can occur during perioperative or postoperative follow-up in obese patients. Minimal invasive nature and high efficacy of Retrograde Intrarenal Surgery (RIRS) present itself as a safe and less morbid treatment option. In this study, we aimed to compare the efficacy and safety of RIRS in the treatment of kidney stones in different BMI levels. Material and Methods: Files of 552 patients who underwent RIRS for renal stones between January 2012 and December 2017 were reviewed. We classified patients according to the World Health Organisation classification. These three groups were compared for stone-free rate, complication rate, operative and fluoroscopy times and length of hospital stay. Results: The stone-free rate (SFR) of the study population was 80.8%. It was 81% for Group 1, 83.7% for Group 2 and 77.7% for Group 3. There was no statistically significant difference between the three groups among SFR (p=0.346). Clinical insignificant residual fragments (CIRF) status was also similar among the three groups (p=0.254). Complication rates between the three groups were statistically similar (p=0.416). Conclusion: In this study, we have shown that RIRS is a suitable option for all urolithiasis patients, even for obese individuals. Stone-free rates, length of hospital stay, operation time and complication rates in obese patients are similar with non-obese patients. Keywords: urolithiasis; obesity; laser lithotripsy

Retrograde intrarenal surgery for the treatment of renal stones in patients with a solitary kidney: Does access sheath matter?

BackgroundTreating renal stones in patients with a solitary functioning kidney is challenging. The present study was aimed to assess the competence and safety of retrograde intrarenal surgery (RIRS) for the treatment of renal stones in a solitary kidney.MethodsBetween August of 2017 and August of 2019, 25 ensuing patients with a solitary kidney and renal calculi and who were treated with RIRS were prospectively enlisted in the study. All patients were assessed by non-contrast computed tomography before surgery. Stone-free status was determined if there were no residual fragments. The final stone-free rates (SFRs) were assessed 3 months after the last treatment session by plain X-ray KUB and ultrasonography. Patient demographics, perioperative and postoperative outcomes were prospectively evaluated. Serum creatinine levels and glomerular filtration rate (GFR) pre-procedure and during follow-up were correlated.ResultsTwenty-five patients underwent 26 procedures. The mean patient age was 42.81 ± 12.3 (range 22–67) years. The mean stone size was 18.23 ± 6.27 mm (range 9–25 mm) and the mean operative time was 46.15 ± 15.34 min (range 25–100 min). A ureteral access sheath (UAS) was used in five (19.2%) pre-stented patients. One patient (3.8%) required the second stage RIRS for residual stones. The SFR after the initial and final procedures, the SFR was 84% and 92%, respectively.The mean serum creatinine levels were significantly reduced post-surgery compared to preoperative levels (1.76 ± 1.21 mg/dL; 1.37 ± 0.60 mg/dL; p value 0.001) while GFR not encounter any significant variation post-surgery (63.04 ± 33.16 ml/min) compared to preoperative rates (61.12 ± 34.76 ml/min, p value 0.502). Minor complications classified as Clavien I or II developed in 5 patients (20%). Clavien IIIb, a major complication, developed in one (4%) patient, which was caused by steinstrasse and necessitated emergency surgical intervention.ConclusionRenal stones in a solitary kidney can be managed using RIRS safely and effectively with and without the use of UAS, without compromising renal function.

Comparison of Efficiency and Safety of Retrograde Intrarenal Surgery and Micropercutaneous Nephrolithotomy in Pediatric Kidney Stones Smaller than 2 cm: A Prospective Cohort Study.

Objective: To compare the safety and efficacy of two minimally invasive surgical techniques used for pediatric stone disease: retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (micro-PCNL). Materials and Methods: A prospective study was designed to include children aged <15 years with a single stone <20 mm. Sixty-four patients were assigned to undergo either an RIRS or a micro-PCNL (1:1 ratio). Demographic parameters, stone size, location, operative data, complications, stone-free status, and efficacy quotient were compared. Results: Due to anatomic considerations, seven patients were shifted to the micro-PCNL arm, thus resulting in 39 micro-PCNLs performed vs 25 RIRS in the end. Because of the deviation from planned surgery that was significantly higher in the RIRS group (p = 0.011), the analysis was done in a prospective cohort comparison. Stone-free rates were similar for micro-PCNL and RIRS groups (80% vs 82.2%). The operative (median 60 vs 90 minutes, p < 0.001), fluoroscopy (median 15 vs 30 seconds, p = 0.004), and lithotripsy times (median 15 vs 25 minutes, p = 0.007) were shorter in the RIRS group. However, despite the larger stone size, the efficiency quotient was significantly higher in the micro-PCNL group (82.1% vs 54.1%; p = 0.009). None of the patients experienced significant hematuria requiring blood transfusion, as well as no ureteral orifice obstructive complication was detected within the follow-up period. Conclusion: RIRS and micro-PCNL techniques in children have similar stone-free and complication rates. The operative, fluoroscopy, and lithotripsy times were shorter, deviation from the planned surgery, and the number of sessions under anesthesia was higher in the RIRS group. Despite the larger stone size, efficacy quotient was significantly higher in the micro-PCNL group.

Regional vs General Anesthesia for Retrograde Intrarenal Surgery: A Systematic Review and Meta-Analysis.

Purpose: To determine the effectiveness and safety of retrograde intrarenal surgery (RIRS) under regional anesthesia (RA) vs general anesthesia (GA). Methods: In February 2020, a comprehensive search of PubMed, EMBASE, Web of Science, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry was performed to find eligible studies comparing outcomes of GA and RA during RIRS procedure. Result parameters, including stone-free rate (SFR), operation time, postoperative length of stay, postoperative first-day visual analog scale (VAS) score, and complication rates were assessed using RevMan 5.3. Results: Six studies (five randomized controlled trials and one retrospective study) with 1747 individuals were included. Pooled results revealed no statistical difference exist concerning SFR (odds ratio [OR] = 1.07, p = 0.63), postoperative length of stay (weighted mean difference [MD] = 0.08, p = 0.54), postoperative first-day VAS score (MD = -0.10, p = 0.23), and complication rates (OR = 0.91, p = 0.46). However, the RA group had shorter operation time (MD = -5.41, p < 0.00001) compared with GA group. Conclusion: The present study showed that RA demonstrated shorter operation time than GA, and was similar to GA regarding SFR, postoperative length of stay, postoperative first-day VAS score, and complication rates. We considered that RA might be a better alternative with prudent patient selection.

Retrograde Intrarenal Surgery Following Laser Endopyelotomy; Sequential Procedures for Ureteropelvic Junction Obstruction and Nephrolithiasis.

This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) andstone disease. Patients with concomitant UPJO and renal stone disease who were first treated in ourclinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matchedwith those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results werecompared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRSfollowing rLEP were independently evaluated and factors affecting the success of sequential procedures wereinvestigated. The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normalanatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors inthe sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stonesize and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%obstruction-free rate. RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It canbe used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.

Application of flexible ureteroscopy combined with holmium laser lithotripsy and their therapeutic efficacy in the treatment of upper urinary stones in children and infants.

To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) for the treatment of pediatric patients. A total of 45 patients with upper urinary stones treated using flexible ureteroscopy combined with holmium laser lithotripsy at our department between June 2015 and January 2017 were examined in this study. The operative success rate of treatment using holmium laser lithotripsy via flexible ureteroscopy was 97.8% (44/45); one patient (1/45, 2.2%) was converted to laparoscopic pyelolithotomy, and the calculus was successfully removed. Lithotripsy via flexible ureteroscopy was successful during the first phase in 38 patients (38/45, 84.4%), and second or third phase lithotripsy was needed for six patients (6/45, 13.3%). Intraoperative ureteral fracture in the middle and lower sections occurred in one pediatric patient who was converted to laparoscopic pyelolithotomy and ureter bladder reimplantation. This patient was discharged after recovery at 2 weeks postoperative and showed no significant renal dysfunction over the 12-month follow-up period. Severe postoperative gross hematuria occurred in one patient, who improved after hemostasis and other symptomatic treatments. High fever occurred in two patients (body temperature >39°C), who later improved. These pediatric patients were discharged after active anti-infection and other conservative treatments for 4 days. All of the included patients were followed up for 2-15 months, with an average follow-up period of 8 months. The total calculus clearance rate was 100% (45/45), with no recurrence of the calculus. In this study, most upper urinary stones in children and infants were treated successfully with holmium laser lithotripsy applied via flexible ureteroscopy.

Clinical Outcomes of Retrograde Intrarenal Surgery as a Primary Treatment for Staghorn Calculi: A Single-Center Experience

Objective: We investigated the efficacy and safety of retrograde intrarenal surgery (RIRS) as a primary treatment for staghorn calculi. Methods: From 2012 to 2016, we identified 39 patients with staghorn calculi who received RIRS as a primary treatment. During the study period, no staghorn calculi were treated primarily with percutaneous nephrolithotomy or any other modality. A stone-free status after RIRS was defined as no detectable stone fragments on X-rays or computed tomography scans. Results: Of 39 patients who received 134 procedures (median 3 procedures per patient; range: 1-11; mean stone length: 60.5 ± 23.0 mm), 18 (46%) and 21 (54%) had staghorn calculi &lt;60 and &gt;60 mm in maximum length, respectively. The stone-free rates after the first and final procedures were 21% (8 of 39) and 62% (24 of 39), respectively; overall, 39% (7 of 18) and 78% (14 of 18), respectively, for the 18 patients with &lt;60 mm staghorn calculi; and 5% (1 of 21) and 48% (10 of 21), respectively, for the 21 patients with &gt;60 mm calculi. Multivariate analysis revealed a maximum stone length &gt;60 mm to be the only independent predictor of a stone-free status after the first and final procedures. During the treatment series, perioperative complications occurred in 16 (41%) patients. Only one patient presented with a Clavien-Dindo grade III complication (malposition of a ureteral stent). Conclusions: RIRS is a safe and effective treatment option for staghorn calculi.

Safety and reliability of fluoroscopy-free technique in retrograde intrarenal surgery.

Traditional retrograde intrarenal surgery is performed under fluoroscopic guidance. In the present study, we assessed the efficacy and safety of retrograde intrarenal surgery without fluoroscopic guidance in selected patients with renal and proximal ureteral stone disease. Between October 2013 and August 2016, a total of 350 patients who underwent retrograde intrarenal surgery for upper urinary tract stone disease were retrospectively analyzed. Ninety-five (Group 1) and 255 (Group 2) patients underwent retrograde intrarenal surgery with and without fluoroscopy guidance, respectively. We documented complications and success rates of the procedures retrospectively. The mean age of the patients was 45.3 years. The mean stone size was 14.5±5.5 (5-30) mm and 13.7±5.2 (4-30) mm in Group 1 and 2, respectively (P=0.197). The stone-free rates one month after surgery were 86.3% and 87% in Group 1 and 2, respectively (P=0.739). The overall incidence of intraoperative complication was 16.3%. In Group 1, incidence of intraoperative complication was 17.9% (N.=17) while in Group 2 incidence was 15.7% (N.=40) (P=0.620). The overall postoperative complication rate was 5.1%. Postoperative complications developed in seven patients (7.4%) in Group 1 and in 11 patients (4.3%) in Group 2 (P=0.250). Fluoroscopy-free retrograde intrarenal surgery seems to be technically feasible and safe for the treatment of renal and proximal ureteral stone disease in uncomplicated selected cases.

Outcome of retrograde flexible ureterorenoscopy and laser lithotripsy for treatment of multiple renal stones

ObjectiveTo evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (F-URS) and laser lithotripsy as a treatment option for multiple renal stones greater than 1cm. Patients and methodsBetween June 2015 and February 2017, 42 patients who were treated with RIRS via F-URS and laser lithotripsy were evaluated. Stones were divided into two categories according to stone burden, 11–20mm and 21–30mm. Patient's demographics, stones characteristics, operative outcomes and complications were evaluated prospectively. Stone free rate (SFR) was determined 4 weeks postoperatively using findings on non-contrast computed tomography (NCCT). ResultsMean stones burden was 25.7mm (range from 1.3 to 30mm), 8 patients had 11–20mm stones burden with SFR 100% and 34 had 21–30mm stone burden with SFR 91.2%. The overall SFR was 92.8%. Multiple stones were two in 31 patients (73.8%), three in 9 (21.4%) and four in 2 (4.8%). Regarding stone number per kidney and SFR, SFR was 100%, 77.7% and 50% for kidneys with two, three and four stones respectively. In terms of stone location in the pelvi-calyceal system and corresponding SFR, there were renal pelvic stones in 6 (14.3%) patients with 100% SFR, upper calyx and or mid calyx and or renal pelvis in 12 (28.6%) with SFR 91.6% and lower calyx with or without other locations in 24 with SFR 91.6% also. Complications were minor and included, UTI in 3 patients (7.1%), hematuria of 4 days duration in 2 (4.8%), severe DJ stent irritative symptoms in one (2.4%) and minor ureteral perforations in one (2.4%). ConclusionRIRS via F-URS and laser lithotripsy is a safe and effective treatment option with high success rate for patients with multiple renal stones of 11–30mm stone burden. It is indicated when other stone treatment modalities contraindicated or have failed. However, for complex or challenging stones, staged procedures may be required.

A comparison of micro-PERC and retrograde intrarenal surgery results in pediatric patients with renal stones

With advancements in endoscopic surgery, open surgical techniques for urinary system stones have paved the way for the application of less invasive treatment modalities in patients with pediatric kidney stone disease. These treatment options include extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS). We aimed to compare the efficacy and safety of RIRS and micro-PCNL techniques in the surgical treatment of kidney stones in pediatric patients. A total of 48 pediatric patients, who underwent RIRS or micro-PERC for pediatric kidney stone disease, were retrospectively analyzed. Urinalysis, urine culture, serum creatinine (Cr), blood urea nitrogen (BUN), calcium, phosphorus, parathyroid hormone, 24-hour urine sample, complete blood count (CBC), urinary system X-ray, kidney ureter bladder (KUB), and urinary system ultrasonography (USG) test results were evaluated prior to the procedure. Intravenous pyelography (IVP), non-contrast computed tomography (CT), and renal scintigraphy evaluations were also performed, if necessary. The patients were divided into two groups: micro-PERC group (n=25) and RIRS group (n=23). Data relating to the duration of the operation, duration of fluoroscopy, length of hospitalization, complication rates, and stone-free rates were recorded. The mean ages of the micro-PERC and RIRS groups were 4±2.3 and 10.9±3 years, respectively (p=0.001). However, the mean stone sizes were 12.2±2.8 and 13.7±3.5mm, respectively (p>0.05). The mean duration of operation was 75.1±18.9min in the micro-PERC group and 62.3±15.3min in the RIRS group (p>0.05). In addition, the mean duration of fluoroscopy was 115±35.4s in the micro-PERC group and 39.9±15.3s in the RIRS group. The stone-free rates in the micro-PERC and RIRS groups following the procedure were reported to be 84% (21/25) and 82.6% (19/23), respectively (p>0.05). In terms of the degree of preoperative hydronephrosis between the groups, the rates of mild and moderate-severe disease were 76% (19 out of 25) and 24% (6 out of 25), and 69.5% (16 out of 23) and 30.4% (7 out of 23) in the micro-PERC and RIRS groups, respectively. In recent years, technological developments in minimally invasive procedures, such as micro-PERC and RIRS, have facilitated choices made by urologists in the effective and safe first-line treatment in pediatric patients.

Retrograde intrarenal surgery in the management of pediatric cystine stones

To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones. Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates. Mean age of the 14 cases was 10.9±2.2 years (range: 7-15). Mean stone size was 13.6±2.4mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2±7.2min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7±5.2 months, stone recurrence was noted in one patient. Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period. The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.

The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones: a propensity score analysis.

The aim of this study is to evaluate if surgical experience could influence the outcomes of retrograde intrarenal surgery (RIRS) in terms of stone clearance and complication rate. Patients from five institutions were included in this study. Patients were divided into two groups. Group 1: patients treated by three surgeons in the early phase of learning curve (surgical experience <100 procedures); Group 2: cases operated by two surgeons with great endourological experience (>400 procedures). Patients and stone characteristics, outcome and complications were analyzed. Multivariable regression model was used. Differences between groups were estimated using propensity scores to adjust for the bias inherent to the different characteristics. 381 RIRS were analyzed (Group 1: 150 RIRS; Group 2: 231 RIRS). Clinical data and stone parameters were comparable. The SFR was 70% in Group 1 and 77.9% in Group 2 (p=0.082). Operative time was significantly shorter in the Group 2 (76.3 vs. 53.1min, p=0.001). The overall complication rate was significantly lower in Group 2 (20.7 vs. 8.7, p=0.001). At unadjusted analysis, a non-significant difference was found between centers on SFR (OR 1.51 95% CI 0.95-2.41). Conversely, a significant difference was found on overall complications (OR 0.36 95%CI 0.20-0.67) with lower overall complication in Group 2. This study shows that surgeon experience influences the outcomes of RIRS mainly in terms of safety. Further studies will be needed to assess the exact number of procedures necessary to obtain a plateau in the rate of complications and success.

Retrograde Intrarenal Surgery is equally efficient and safe in patients with different American Society of Anesthesia physical status

Objective To assess the efficacy and safety of Retrograde Intrarenal Surgery to treat renal stones in patients with different American Society of Anesthesia (ASA) physical status. Material and methods We performed a retrospective analysis of 150 patients who underwent Retrograde Intrarenal Surgery for renal stone between October 2013 and December 2014. Patients were categorized into three groups according to their ASA physical status: ASA Class 1 (Group 1, n = 23), ASA Class 2 (Group 2, n = 113) and ASA Class 3 (Group 3, n = 14). We documented and stratified the per-operative and postoperative complications according to modified Satava Classification System and Clavien–Dindo Classification. Results The mean age of the patients was 44 years. The total stone-free rate was 81.2%. According to the groups, the stone-free rate was 75% in Group 1, 82.5% in Group 2, and 83.3% in Group 3 (p = 0.340). Per-operative and postoperative complications were recorded in 12% (n = 18) and 5.3% (n = 8) of the patients. We did not find significant difference in terms of per-operative and postoperative complication rates among patients with different ASA physical status (pper-operative = 0.392 and ppostoperative = 0.136). Conclusions Retrograde Intrarenal Surgery is an effective and safe surgery with high stone-free rates and low morbidity in patients with different ASA physical status.

Pediatric retrograde intra-renal surgery for renal stones &lt;2 cm in solitary kidney

Introduction:Management of renal stones in children with a solitary kidney is a challenge. In the current study, the efficacy and safety of retrograde intrarenal surgery (RIRS) in these children were determined.Patients and Methods:Records of children with renal stones who were treated at our institute between August 2011 and August 2014 were retrospectively assessed. Inclusion criteria were: Children with single renal stone <2 cm size, in a solitary kidney. A 7.5 Fr flexible ureteroscope (FURS) was introduced into the ureter over a hydrophilic guidewire under visual and fluoroscopic guidance - applying a back-loading technique. The stone was completely dusted using 200 μm laser fiber (0.2–0.8 joules power and 10–30 Hz frequency). At the end of the maneuver, a 5 Fr JJ stent was inserted into the ureter. The children were discharged home 24 h postoperative - provided that no complications were detected.Results:Fourteen children (3 girls and 11 boys) with median age 9.5 years (range 6–12) were included. The mean stone burden was 12.2 ± 1.5 mm (range 9–20). Stones were successfully accessed in all of the cases by the FURS except for 2 cases in whom a JJ stent was inserted into the ureter and left in place for 2 weeks to achieve passive dilatation. All of the stones were dusted completely. The immediate postoperative stone-free rate (SFR) was 79%, and the final SFR was 100% after 3 weeks. No intraoperative complications were observed.Conclusions:RIRS for renal stone <2 cm in children with a solitary kidney is a single-session procedure with a high SFR, low complication rate, and is a minimally invasive, natural orifice technique.

Safety and efficacy of retrograde intrarenal surgery in patients of different age groups

ObjectivesTo assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. Patients and methodsWe performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analyzed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤15 years at surgery (group I, n=51), 16–60 years (group II, n=726) and >60 years (group III, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. ResultsThe stone-free rate was 78.4% in group I, 77.5% in group II, and 81.1% in group III (p=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group I, 5.6% group II, and 7.6% in group III. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group II and 2 patients (1.1%) in group III. A 48-year-old man died from septic shock 5 days after the surgery. ConclusionsRIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.

Seguridad y eficacia de la cirugía retrógrada intrarrenal en pacientes de diferentes grupos de edad

ObjectivesTo assess the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in different age groups of patients. Patients and methodsWe performed a retrospective analysis of 947 patients who underwent RIRS for renal calculi between January 2008 and January 2014. Age at RIRS was analysed both as a continuous and categorical variable and patients were categorized into three age groups; aged ≤ 15 years at surgery (group i, n=51), 16 - 60 years (group Ii, n=726) and>60 years (group iii, n=170). We compared the 3 groups with the regard to stone characteristics, operative parameters and postoperative outcomes. ResultsThe stone-free rate was 78.4% in group i, 77.5% in group ii, and 81.1% in group iii (P=.587). A multivariate logistic regression analysis showed that only stone size and stone number had significant influence on the stone-free rates after RIRS. Intraoperative complications occurred 13.7% in group i, 5.6% group ii, and 7.6% in group iii. Overall complication rates in children were higher than adult patients but the differences were not statistically significant. We found that only operation time was associated with the increased risk of intraoperative complications. Peroperative medical complications developed in 8 patients (.8%) in group ii and 2 patients (1.1%) in group iii. A 48-year-old man died from septic shock 5 days after the surgery. ConclusionsRIRS was observed to be a safe and effective procedure in all age groups of patients with stone disease, therefore age should not be considered as a limiting factor.

Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review

The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. A literature search was performed in July 2014 using PubMed, Embase, and Web of Science databases. Literature reviewed included meta-analysis and randomized and nonrandomized controlled studies to identify relevant studies for the meta-analysis. Six randomized and eight nonrandomized studies were identified for analysis. PCNL provided a significantly higher stone-free rate (SFR) compared with RIRS and SWL. Furthermore, no statistical significant difference was found when PCNL was compared with RIRS and SWL for complication rate. Compared with the other two treatments, RIRS had a longer operative time and PCNL had a longer hospital stay. SWL was associated with significantly higher re-treatment rate compared with RIRS and PCNL, whereas there were no significant differences in auxiliary procedure rates among the three treatment techniques. RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

Objective: To systematically review the efficacy and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi >2 cm. Methods: We searched PubMed, Cochrane Library, Embase and the Chinese Biomedical Literature Database about RIRS and PCNL for the treatment of renal stones. The retrieval time ended in December 2013. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.2 software. Results: Two randomized controlled trials and six clinical controlled trials were included, involving a total of 590 patients. Our meta-analysis showed that there were not significant differences in stone-free rate (relative risk [RR] = 0.95, 95% confidence interval (CI) 0.88-1.02, p = 0.11) and fever (RR = 0.95, 95% CI 0.54-1.67, p = 0.85) between RIRS and PCNL. We found that hospital stay (weighted mean difference [WMD] = -2.10, 95% CI -3.08 to -1.11, p < 0.10) and bleeding (RR = 0.20, 95% CI 0.06-0.68, p = 0.01) were lower and operation time was longer (WMD = 19.11, 95% CI 7.83-30.39, p < 0.10) for RIRS. Conclusion: RIRS is a safe and effective procedure. It can successfully treat patients with stones >2 cm with a high stone-free rate and significantly reduce hospital stay without increasing complications. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.