Retrograde intrarenal surgery for management of kidney stones smaller than 20 mm: A singe center experience of 452 cases

Correspondence (İletişim): Ramazan Topaktaş, M.D. Saglik Bilimleri Universitesi Hamidiye Tip Fakultesi, Haydarpasa Numune Saglik Uygulama ve Arastirma Merkezi, Uroloji Anabilim Dali, Istanbul, Turkey Phone (Telefon): +90 505 913 95 61 E-mail (E-posta): ramazantopaktas@yahoo.com Submitted Date (Başvuru Tarihi): 14.12. 2018 Accepted Date (Kabul Tarihi): 22.12. 2018 Copyright 2020 Haydarpaşa Numune Medical Journal OPEN ACCESS This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 86 Topaktaş et al., Flexible Ureteroscopy for Urolithiasis up to 20 mm / doi: 10.14744/hnhj.2018. 10337 percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and laparoscopic surgery can be applied in place of open surgery. The ideal treatment would be complete stone clearance in a single session with minimum trauma to the patients and prevention of new stone formation. The preference among the treatments depends on size, hardness and position of stone and experience of the surgeon [4,5]. With advanced and highly qualified imaging modalities in technology, minimally invasive methods are all used more effectively for the management of renal stones. Technical improvements, including endoscope miniaturization, improved deflection mechanism, enhanced optical quality and tools, and introduction of disposables, have led to increased use of RIRS for renal stones. The purpose of all these technological developments is to provide the least morbidity and achieve no stone state. According to the European Association of Urology guidelines, the use of flexible ureterorenoscopy (f–URS) as reliable and efficient alternative usually for the patients with obesity, complex anatomical kidney, musculoskeletal deformities, bleeding diathesis, unsuccessful ESWL procedure, and stones with size less than 2 cm [6]. Although PCNL with enhanced morbidity for compact and rigid stones larger than 2 cm in diameter has been suggested as a first-line treatment, f-URS can be performed as an alternative surgical treatment for this type of stone [6,7]. In the present study, we have retrospectively analyzed and presented outcomes of 452 patients who underwent RIRS due to different size kidney stones in the last five years. Materials and Methods In this study, we retrospectively reviewed medical records of 452 patients who underwent RIRS for renal stones at Istanbul Haydarpasa Numune Training and Research Hospital from January 2013 to February 2018. This study was conducted in compliance with ethical principles defined in the Helsinki Declaration. Approval was obtained from the scientific committee of our hospital, and written informed consent was obtained from all participants and/or relatives before the operations. This study included patients with kidney stones with smaller than 20 mm, ESWL-refractory, or previously failed ESWL, patients associated with musculoskeletal deformities and bleeding disorders. Demographic data of patients, size and site of stones, duration of operation, stone-free rates, and duration of hospital stay were investigated. All the patients were preoperatively evaluated using a physical examination, routine blood tests, coagulation tests, urinalysis, urine culture, direct urinary system graphy (KUB), urinary system ultrasound (US), non-contrasted computed tomography (CT) and/or intravenous pyelography (IVP). Patients with positive urine cultures were adequately treated with appropriate antibiotics, and all the patients had a negative urine culture before surgery. Stone size was determined by measuring the longest axis on the preoperative radiologic investigation. In patients with multiple renal stones, the stone size was calculated as the sum of the greatest dimensions of each stone.