Factors affecting stone-free rates in retrograde intrarenal surgery

Year 2022, Volume: 14 Issue: 2, 42 - 48, 31.05.2022

Uğur Öztürk , Emrah Küçük , Mehmet Özen , Mustafa Koray Kırdağ , Turgut Serdaş , Varol Nalçacıoğlu , Mustafa Aydın , Mustafa Kemal Atilla

https://doi.org/10.54233/endouroloji.1091342

Abstract

Objective: We aimed to determine the factors that are effective in achieving stone-free status (SFS) in patients who underwent retrograde intrarenal surgery for kidney stones.
Material and Methods: We retrospectively analyzed the data of 160 patients who underwent retrograde intrarenal surgery (RIRS) in our clinic between January 2021 and July 2021. Demographic characteristics of the patients, parameters related to stone and renal calyceal anatomy measured on computed tomography (CT) images, use of ureteral access sheath (UAS) and surgical time were analyzed. Surgery was considered successful if the residual stone on direct urinary system radiography (DUSG) or CT images at the postoperative 1st month was smaller than 2 mm or there was no stone at all. The patients were divided into two groups according to their stone free status (SFS), as stone free (Group 1) and with residual stone (Group 2). In addition, stones in the kidney were divided into lower poles (45 degrees and above and below) and non lower pole according to localization. The groups were compared according to the presence of postoperative residues.
Results: There was no difference for the distribution of gender, body mass index (BMI), side, UAS use, opacity status, infundibulopelvic angle (IPA) and infundibular length for Group 1 and Group 2 (p>0.05). Infundibular width was greater in Group 1 without stone (p>0.021). The residual in patients with more than one stone was higher than those with one stone (p>0.048). We did not find impressive results on stone-freeness for stone volume and stone density. According to the localization in the kidney, the residue was higher in those with lower poles (p>0.001). However, there was no difference between those with lower pole stones and those above and below 45 degrees (p>0.050).
Conclusion: In the treatment of retrograde intrarenal stone surgery, the presence of more than one stone, the presence of lower pole stones, and the small infundibular width can be predicted as factors that negatively affect stone clearance.

Keywords

retrograd intrarenal cerrahi, böbrek taşı, taşsızlık

Retrograde intrarenal cerrahide taşsızlık oranlarını etkileyen faktörler

Abstract

Amaç: Böbrek taşı nedeniyle retrograt intrarenal cerrahi uygulanan olgularda taşsızlık elde etmede etkili olan faktörleri saptamayı amaçladık.
Gereç ve Yöntemler: Ocak 2021- Temmuz 2021 tarihleri arasında kliniğimizde retrograt intrarenal cerrahi (RİRC) uygulanan 160 olgunun verilerini retrospektif olarak analiz ettik. Hastaların demografik özellikleri, bilgisayarlı tomografi (BT) görüntüleri üzerinden ölçümü yapılan taş ve böbrek kalisiyel anatomisi ile ilgili parametreleri, üreter erişim kılıfı (ÜEK) kullanılma durumu ve cerrahi süre analiz edildi. Postoperatif 1.ayda direkt üriner sistem grafisi (DÜSG) veya BT görüntülerindeki rezidü taşın 2 mm’den küçük olması veya hiç taş olmaması cerrahi için başarılı kabul edildi. Hastalar taşssızlık durumuna göre taşsız (Grup1) ve rezidü taşa sahip (Grup 2) olmak üzere iki gruba ayrıldı. Ayrıca böbrekteki taş lokalizasyona göre alt pol olan (45 derece ve üstü ile altı) ve olmayan diye alt grublara ayrıldı. Gruplar operasyon sonrası rezidü varlığına göre kıyaslandı.
Bulgular: Grup 1 ve Grup 2 için cinsiyetin dağılımları, vücut kitle indeksi (VKİ), taraf, ÜEK kullanımı, opasite durumu, infindibulopelvik açı (İPA) ve infundibuler uzunluk için fark yoktu (p>0,05). Taşssız olan Grup 1’de infundibuler genişlik daha fazla idi (p>0,021). Birden fazla taşı olanlarda rezidü, tek taşı olanlara göre fazla idi (p>0,048). Taş hacmi ve taş dansitesi için taşsızlık üzerine etkileyici sonuç bulmadık. Böbrekteki lokalizasyona göre alt pol olanlarda rezidü fazlaydı (p>0,001). Ancak alt pol taşları olanlarda 45 derece üstü ve altı olanlar arasında fark yoktu (p>0,050).
Sonuç: Retrograd intrarenal taş cerrahisi tedavisinde, birden fazla taşın olması, alt pol taşın olması, infundibüler genişliğin az olması taşsızlığı olumsuz etkileyen faktörler olarak öngörülebilir. 

Keywords

retrograt intrarenal cerrahi, böbrek taşı, taşsızlık

References

• Inoue T, Okada S, Hamamoto S, Yoshida T, Matsuda T. Current trends and pitfalls in endoscopic treatment of urolithiasis. Int J Urol. 2018;25:121–133.
• Elbir F, Başıbüyük İ, Topaktaş R, Kardaş S, Tosun M, Tepeler A, Armağan A. Flexible ureterorenoscopy results: Analysis of 279 cases. Turk J Urol. 2015 Sep;41(3):113-8. doi: 10.5152/tud.2015.81488.
• Schoenthaler M, Wilhelm K, Katzenwadel A, Ardelt P, Wetterauer U, Traxer O, et al. Retrograde intrarenal surgery in treatment of nephrolithiasis: is a 100% stone-free rate achievable? J Endourol. 2012;26:489–93.
• Tonyalı Ş, Yılmaz M, Karaaslan M, Ceylan C, Işıkay L. Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones. Turk J Urol. 2018 Nov;44(6):473-477. doi: 10.5152/tud.2018.88615.
• Wang C, Wang S, Wang X, Lu J. External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery. BMC Urol. 2021 Mar 4;21(1):33. doi: 10.1186/s12894-021-00801-y
• Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score". Urology. 2012 Sep;80(3):512-8. doi: 10.1016/j.urology.2012.02.072. Epub 2012 Jul 26.
• Xiao Y, Li D, Chen L, Xu Y, Zhang D, Shao Y, Lu J. The R.I.R.S. scoring system: An innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery. BMC Urol. 2017 Nov 21;17(1):105. doi: 10.1186/s12894-017-0297-0.
• Favorito LA. Lower pole renal stone: flexible ureteroscopy or shockwave lithotripsy? The anatomy is the key. Int Braz J Urol. 2018 Mar-Apr;44(2):211-212. doi: 10.1590/S1677-5538.IBJU.2018.02.01.
• Aydın M, Bitkin A, İrkılata L, Keleş M, Küçük E, Bayar G, Atilla MK. Correlation of computerized tomography and intravenous pyelography in the evaluation of pelvicaliceal anatomical measurements. The New Journal of Urology. 2018; 13 (3) :34-37.
• Inoue T, Murota T, Okada S, Hamamoto S, Muguruma K, Kinoshita H, Matsuda T; SMART Study Group. Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones. J Endourol. 2015 Sep;29(9):998-1005. doi: 10.1089/end.2015.0071. Epub 2015 May 15.
• Ozgor F, Kucuktopcu O, Ucpinar B, Gurbuz ZG, Sarilar O, Berberoglu AY, Baykal M, Binbay M. Is There A Difference Between Presence of Single Stone And Multiple Stones in Flexible Ureterorenoscopy And Laser Lithotripsy For Renal Stone Burden < 300mm2 ? Int Braz J Urol. 2016 Nov-Dec;42(6):1168-1177. doi: 10.1590/S1677-5538.IBJU.2015.0646.
• Jessen JP, Honeck P, Knoll T, Wendt-Nordahl G. Flexible ureterorenoscopy for lower pole stones: influence of the collecting system's anatomy. J Endourol. 2014 Feb;28(2):146-51. doi: 10.1089/end.2013.0401. Epub 2013 Nov 19.
• Jacquemet B, Martin L, Pastori J, Bailly V, Guichard G, Bernardini S, Chabannes E, Bittard H, Kleinclauss F. Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations. J Endourol. 2014 Oct;28(10):1183-7. doi: 10.1089/end.2014.0286.
• Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ. Nefrolitiazis için endoskopik litotripsinin başarı oranlarına taş yerleşiminin etkisi. Üroloji. 2008; 71 :214–217.
• Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH. Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol. 2010 Nov;51(11):777-82. doi: 10.4111/kju.2010.51.11.777. Epub 2010 Nov 17.
• Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L, Somani BK. Impact of ureteral access sheath on renal stone treatment: prospective comparative non-randomised outcomes over a 7-year period. World J Urol. 2020 May;38(5):1329-1333. doi: 10.1007/s00345-019-02878-5.