Effects of renal parenchymal volume and total renal volume on success in retrograde intrarenal surgery

Yıl 2022, Cilt: 14 Sayı: 1, 7 - 16, 31.01.2022

Sedat Taştemur Samet Şenel Esin Ölçücüoğlu Yusuf Kasap Emre Uzun

https://doi.org/10.54233/endouroloji.1011076

Öz

Objective: Renal parenchymal volume known as an indicator of the number of nephrons in the kidney. We predict that the increase in renal parenchyma volume will increase diuresis and facilitate the excretion of fragments after RIRS procedure. Therefore, increased renal parenchymal volume might be suggested as a factor affecting the success of RIRS procedure.
Material and Methods: Out of 238 patients who underwent RIRS in our clinic, 104 patients who underwent primary RIRS due to single kidney stone and who underwent contrast-enhanced computed tomoghraphy were included in the study. The demographic, clinical and radiological (renal parenchymal volume and total renal volume) datas of all patients included were evaluated. Patients were divided into 2 groups according to the success status after RIRS, as successful and unsuccessful groups.
Results: There was no significant difference in total renal volume between the two groups (213.3±54.9 cm3 in the successful group, 204.4±65.7 cm3 in the unsuccessful group, p=0.521). While the mean renal parenchymal volume in the successful group was 168.3±46.1 cm3 , it was 125.5±29.9 cm3 in the unsuccessful group, and the difference was statistically significant (p<0.001). In the ROC analysis, the cut-off value for renal parenchymal volume predicting the presence of residual stones after RIRS was found to be ≤141.3 cm3. According to multivariate logistic regression analysis, elevated stone burden (OR=1.02; 95% Cl=1.009-1.03; p<0.001), localized stones in the lower pole (OR=31.673; 95% Cl=3.315-302.623; p=0.003 ) and RPV≤141.3 cm3 (OR=5.923; 95% Cl=2.886-19.263; p=0.008) were found to be independent risk factors for success of RIRS procedure.
Conclusion: Renal parenchymal volume is a practical and cost-effective parameter that can be used to predict success rates in patients undergoing RIRS for kidney stones.

Anahtar Kelimeler

Renal parenchymal volume, RIRS, stone, success, total renal volume

Renal parankimal hacim ve total renal hacmin retrograd intrarenal cerrahi başarısına etkisi

Öz

Amaç: Renal parankimal hacim böbrekteki nefron sayısının bir göstergesidir. Renal parankim hacimdeki artışın diürezi artıracağı ve retrograd intrarenal cerrahi (RİRC) sonrası fragmanların atılımını kolaylaştıracağını öngörmekteyiz. Dolayısıyla artan renal parankimal hacim, RİRC başarısına etki eden bir faktör olabilir.
Gereç ve Yöntemler: Kliniğimizde RİRC uygulanan 238 hastadan tek böbrek taşı nedeniyle primer RİRC yapılan ve öncesinde kontrastlı bilgisayarlı tomografi uygulanan 104 hasta çalışmaya dahil edildi. Dahil edilen tüm hastaların demografik, klinik ve radyolojik (renal parankim hacmi ve toplam renal hacim) verileri değerlendirildi. Hastalar RİRC sonrası başarı durumlarına göre başarılı ve başarısız olmak üzere iki gruba ayrıldı.
Bulgular: Toplam renal hacim açısından iki grup arasında anlamlı fark yoktu (başarılı grupta 213.3±54,9 cm3, başarısız grupta 204,4±65,7 cm3, p=0,521). Başarılı grupta ortalama renal parankim hacmi 168,3±46,1 cm3 iken, başarısız grupta ortalama 125,5±29,9 cm3 idi ve aradaki fark istatistiksel olarak anlamlıydı (p<0,001). ROC analizinde RİRC sonrası rezidü taş varlığını ön gören renal parankim hacmi için kestirim değeri ≤141,3 cm3 olarak bulundu. Çok değişkenli lojistik regresyon analizine göre, taş yükünün fazla olması (OR=1,02; 95% Cl=1,009-1,03; p<0,001), taşın alt pol yerleşimli olması (OR=31,673; 95% Cl=3,315-302,,623; p=0,003) ve RPV≤141,3 cm3 (OR=5,923; 95% Cl=2,886-19,263; p=0,008) olması RİRC başarısı için bağımsız risk faktörleri olarak bulundu.
Sonuç: Renal parankim hacmi, böbrek taşı nedeniyle RİRC uygulanan hastalarda başarıyı ön görmek için kullanılabilecek pratik ve uygun maliyetli bir parametredir.

Anahtar Kelimeler

Başarı, Renal Parankim Hacmi, RİRC, Taş, Toplam Renal Hacim

Kaynakça

• Demir DO, Doluoglu OG, Yildiz Y, et al. Risk factors for infectious complications in patients undergoing retrograde intrarenal surgery. JCPSP 2019; 29:558-62.
• Türk C (Chair). EAU guidelines on urolithiasis. EAU guidelines 2021.
• Chung JH, Baek M, Park SS, Han DH. The Feasibility of Pop-Dusting Using High-Power Laser (2 J × 50 Hz) in Retrograde Intrarenal Surgery for Renal Stones: Retrospective Single-Center Experience. J Endourol 2021; 35:279-284.
• Sohu S, Soomro MH, Mangrio RH, et al. Efcacy of extracorporeal shockwave lithotripsy with furosemide and hydration in renal stone management: a randomised controlled trial. Arab J Urol 2019; 17:279–284.
• Srivastava A, Sinha T, Karan SC, et al. Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in renal units with impaired function: a prospective controlled study. Urol Res 2006; 34:283–287.
• Koc E, Kamaci D, Gok B, et al. Does the renal parenchymal thickness affect the efficacy of the retrograde intrarenal surgery? A prospective cohort study. Urolithiasis 2021; 49:57-64.
• Tanriover B, Fernandez S, Campenot ES, et al. Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function. Transplantation 2015; 99:66-74.
• Lee YJ, Bak DJ, Chung JW, et al. Is it necessary to actively remove stone fragments during retrograde intrarenal surgery? Investig Clin Urol 2016; 57:274-9.
• Kaplon DM, Lasser MS, Sigman M, Haleblian GE, Pareek G. Renal parenchyma thickness: a rapid estimation of renal function on computed tomography. Int Braz J Urol 2009; 35:5–8.
• Peng L, Wen J, Zhong W, Zeng G. Is physical therapy effective following extracorporeal shockwave lithotripsy and retrograde intrarenal surgery: a meta-analysis and systematic review. BMC Urol 2020; 20:93.
• Eken A, Soyupak B. Retrospective analysis of retrograd intrarenal surgery results and factors affecting success rate. Pam Med J 2018; 11:49-55.
• 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.
• Hyams ES, Bruhn A, Lipkin M, Shah O. Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 2010; 24:1411-4.
• Elbir F, Basibuyuk I, Topaktas R, et al. Flexible ureterorenoscopy results: analysis of 279 cases. Turk J Urol 2015; 41:113-8.
• Resorlu B, Unsal A, Tepeler A, et al. Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology 2012; 80:519-23.
• Ito H, Kawahara T, Terao H, et al. Predictive value of attenuation coefficients measured as Hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 2012; 26:1125-30.
• Gucuk A, Yilmaz B, Gucuk S, Uyeturk U. Are Stone Density and Location Useful Parameters That Can Determine the Endourological Surgical Technique for Kidney Stones That are Smaller than 2 cm? A Prospective Randomized Controlled Trial. Urol J 2019; 16:236-41.
• Martin F, Hoarau N, Lebdai S, et al. Impact of lower pole calculi in patients undergoing retrograde intrarenal surgery. J Endourol 2014; 28:141–5.
• 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.