Comparative evaluation of retrograde intrarenal surgery using ureteral access sheath and fluoroscopy: a retrospective analysis on kidney stone treatment

Abstract

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. 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. 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. 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.

Keywords

• Retrograde intrarenal surgery
• kidney stone
• ureteral access sheath
• fluoroscopy

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

Abstract

Amaç: Bu çalışmada böbrek taşlarının tedavisinde üreteral giriş kılıfı (UAS) ve floroskopi kullanılan ve kullanılmayan retrograd intrarenal cerrahinin (RIRS) sonuçları ve bunun ameliyat sonrası komplikasyonlar üzerindeki etkileri araştırıldı. Yöntemler: Retrospektif bir tasarım kullanarak, böbrek taşı nedeniyle RİRS uygulanan 314 hastanın kayıtlarını analiz ettik. Hastalar floroskopi ve UAS uygulanmasına (Grup 1) ve uygulanmamasına (Grup 2) göre iki gruba ayrıldı. Taşsızlık oranları, rezidüel taş oranları ve ameliyat sonrası komplikasyonlar dahil olmak üzere çeşitli ölçütler gruplar arasında karşılaştırıldı. Sonuçlar: Sonuçlar, hasta yaşı, taş boyutu ve çeşitli demografik parametreler açısından iki grup arasında anlamlı bir fark olmadığını gösterdi. Ancak, UAS ve floroskopi uygulanan Grup 1'e (26.15±5.41 dakika) kıyasla Grup 2'de (20.96±5.97 dakika) operasyon süresinde ile belirgin bir azalma görüldü. Ayrıca, tedavi sonrası sonuçlar, gruplar arasındaki farklar anlamlı olmasa da, rezidüel taş oranlarında bir düşüş ve taşsızlık oranlarında bir artış olduğunu vurgulamıştır. Ateş, idrar yolu enfeksiyonu ve üreter darlığı gibi ameliyat sonrası komplikasyonların insidansı değerlendirildi ve fark olmadığı görüldü. Sonuç: UAS ve floroskopi olmadan RIRS uygulaması, böbrek taşlarının tedavisinde umut verici bir yaklaşım olarak görünmektedir ve UAS ve floroskopi ile geleneksel yönteme kıyasla taş çıkarma etkinliği ve postoperatif komplikasyonlar açısından benzer sonuçlar sunmaktadır. Bu araştırma, daha az invaziv bir yöntemin potansiyelini vurgulamakta ve geniş etkilerini anlamak için daha fazla çalışma yapılmasını gerektirmektedir.

Keywords

• Retrograd intrarenal cerrahi
• böbrek taşı
• üreter giriş kılıfı
• floroskopi

References

1. Venkatachalapathy VSS, Palathullil DG, Sam DM, Prasad A, Abraham GP. Outcomes of retrograde intrarenal surgery in renal calculi of varying size. Indian J Urol. 2022;38(2):128-134.
2. Lim EJ, Traxer O, Madarriaga YQ, et al. Outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World J Urol. 2022;40(5):1223-1229.
3. Gauhar V, Chew BH, Traxer O, et al. Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR). World J Urol. 2023;41(2):567-574.
4. Chai CA, Teoh YC, Tailly T, et al. Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR). Minerva Urol Nephrol. 2023;75(4):493-500.
5. Sforza S, Crisci A, Cini C, Masieri L. Commentary: outcomes and lessons learnt from practice of retrograde intrarenal surgery (RIRS) in a paediatric setting of various age groups: a global study across 8 centres. World J Urol. 2022;40(6):1595-1596.
6. Quhal F, Zeng G, Seitz C. Current evidence for suction in endourological procedures: comprehensive review of literature. Curr Opin Urol. 2023;33(2):77-83
7. Xiang Y, Yan T, Fu M, Quan K, Shu J, Wang R. The regular use of calcium channel blockers before flexible URS appears to facilitate primary UAS insertion: a retrospective study in a single center. Int Urol Nephrol. 2023;55(3):547-551.
8. Özman O, Çınar Ö, Çakır H, et al. Is it a good strategy to proceed a retrograde intrarenal surgery session sheathless after ureteral access sheath insertion failure? a RIRSearch study. J Endourol. 2023;37(7):747-752.

9. Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgery and safety: pressure and temperature. a systematic review. Curr Opin Urol. 2023;33(4):308-317.
10. Weld LR, Nwoye UO, Knight RB, et al. Fluoroscopy time during uncomplicated unilateral ureteroscopy for urolithiasis decreases with urology resident experience. World J Urol. 2014;33(1):119-124.
11. Greene DJ, Tenggadjaja CF, Bowman RJ, Agarwal G, Ebrahimi KY, Baldwin DD. Comparison of a reduced radiation fluoroscopy protocol to conventional fluoroscopy during uncomplicated ureteroscopy. Urology. 2011;78(2):286-290.
12. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-482.
13. Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2023;8(8):Cd007044
14. Mahmood SN, Ahmed CJ, Tawfeeq H, et al. Evaluation of mini-PCNL and RIRS for renal stones 1-2 cm in an economically challenged setting: a prospective cohort study. Ann Med Surg (Lond). 2022;81:104235.
15. 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;38(5):1329-1333.
16. Damar E, Senocak C, Ozbek R, et al. Does ureteral access sheath affect the outcomes of retrograde intrarenal surgery: a prospective study. Minim Invasive Ther Allied Technol. 2022;31(5):777-781.
17. De Coninck V, Somani B, Sener ET, et al. Ureteral access sheaths and its use in the future: a comprehensive update based on a literature review. J Clin Med. 2022;11(17): 5128.
18. Sari S, Çakici MÇ, Kartal IG, et al. Comparison of the efficiency, safety and pain scores of holmium laser devices working with 20 watt and 30 watt using in retrograde intrarenal surgery: One center prospective study. Archivio Italiano di Urologia e Andrologia. 2020;92(2).
19. Bozkurt M, Seker KG. Fluoroscopy-free RIRS on the second session after ureteral stent placement. Urologia. 2023;90(1):130-135.
20. Mahmood SN, Toffeq H, Fakhralddin S. Sheathless and fluoroscopy-free retrograde intrarenal surgery: An attractive way of renal stone management in high-volume stone centers. Asian J Urol. 2020;7(3):309-317.