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

Year 2022, , 1351 - 1354, 25.09.2022

Mehmet Yilmaz Salman , Göksel Bayar , Orhun Sinanoğlu

https://doi.org/10.32322/jhsm.1119226

Cited By: 1

Abstract

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.
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.
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<0.001), and mean session number for each patient was lower in tRIRS group (1.17 vs 1.4 p=0.024). Class 2 or higher complications were occurred in six patients; five was in cRIRS, and one in tRIRS group and rate was similar (p= 0.09).
Conclusions: Inclined Trendelenburg position improves success rate and decrease mean session number and operation time on patients whom performed RIRS for renal pelvis stones. Trendelenburg position has similar complication rate compared to conventional position.

Keywords

Retrograde intrarenal surgery, flexible ureteroscopy, Trendelenburg position, renal pelvis stone

References

• Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 2010; 12: e86-96.
• Abe T, Akakura K, Kawaguchi M. et al. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol 2005; 19: 768–77.
• Ercil H, Alma E, Bas O, et al. Treatment of moderate sized renal pelvis calculi: stone clearance time comparison of extracorporeal shock wave lithotripsy and retrograde intrarenal surgery. Urol J 2016; 13: 2490-5.
• Johnston TJ, Baard J, de la Rosette J, et al. A clinical evaluation of the new digital single-use flexible ureteroscope (UscopePU3022): an international prospective multicentered study. Cent European J Urol 2018; 71: 453-61.
• Skolarikos A, Gross AJ, Krebs A, et al. Outcomes of Flexible ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol 2015; 194: 137–43.
• Cakiroglu B, Sinanoglu O, Tas T, Hazar IA, Balci MB. The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session. Arch Ital Urol Androl 2015; 87: 38-40.
• Pan J, Xue W, Xia L, et al. Ureteroscopic lithotripsy in Trendelenburg position for proximal ureteral calculi: a prospective, randomized, comparative study. Int Urol Nephrol 2014 ;46: 1895-901.
• Zhou R, Han C, Hao L, et al. Ureteroscopic lithotripsy in the Trendelenburg position for extracting obstructive upper ureteral obstruction stones: a prospective, randomized, comparative trial. Scand J Urol 2018; 52: 291-5.
• Bilgasem S, Pace KT, Dyer S, Honey RJ. Removal of asymptomatic ipsilateral renal stones following rigid ureteroscopy for ureteral stones. J Endourol 2003; 17: 397-400.
• Schoenthaler M, Wilhelm K, Katzenwadel A, et al. Retrograde intrarenal surgery in treatment of nephrolithiasis: is a 100% stone-free rate achievable? J Endourol 2012; 26: 489-93.
• Ito H, Kawahara T, Terao H, et al. The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. Urology 2012; 80: 524-8.
• 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; 51: 777-82
• Koo V, Young M, Thompson T, et al. Cost-effectiveness and efficiency of shockwave lithotripsy vs flexible ureteroscopic holmium:yttrium-aluminium-garnet laser lithotripsy in the treatment of lower pole renal calculi. BJU Int 2011; 108: 1913–6.
• Leong WS, Liong ML, Liong YV, Wu DB, Lee SW. Does simultaneous inversion during extracorporeal shock wave lithotripsy improve stone clearance: a long-term, prospective, single-blind, randomized controlled study. Urology 2014; 83: 40-4.
• Humphreys MR, Shah OD, Monga M, et al. Dusting versus Basketing during Ureteroscopy-Which Technique is More Efficacious? A Prospective Multicenter Trial from the EDGE Research Consortium. J Urol 2018; 199: 1272-6.
• 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; 80: 512-8.
• Ito H, Sakamaki K, Kawahara T, et al. Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones. BJU Int 2015; 115: 446-51.
• Danilovic A, Rocha BA, Torricelli FCM, et al. Size is not everything that matters: preoperative CT predictors of stone free after RIRS. Urology 2019; 132: 63-8.