Predictors of Clinical Outcomes of Flexible Ureterorenoscopy with Holmium Laser for Renal Stone Greater than 2 cm

Alqahtani, Saeed M.; Gil-deiz-de-Medina, Sixtina; Traxer, Olivier

doi:10.1155/2012/543537

Cited by 44 publications

(46 citation statements)

References 26 publications

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“…These studies did not focus on URSL or large stones and were therefore excluded. Seventeen further papers were excluded upon reading the full manuscript, leaving 12 papers [7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Resultsmentioning

confidence: 99%

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Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

et al. 2015

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Large renal stones (>2 cm) are managed with percutaneous nephrolithotomy (PCNL), which has a good stone-free rate (SFR) but a relatively high incidence of complications graded Clavien ≥ 3. We wanted to review the literature for the use of ureterorenoscopy and laser fragmentation (URSL) for the management of these stones. A systematic review was done from 1990 to April 2014 for all English language articles reporting on a minimum of 10 patients for stones >2 cm in size (done by 2 reviewers independently) in accordance with the PRISMA and Cochrane review guidelines. A total of 379 articles were identified and after screening for the titles (54) and abstracts (29), 12 papers (651 patients) were included. The male to female ratio was 356:232 with a mean age of 54 years (range 16-86 years). With a mean stone size of 2.7 cm (2-3.15 cm) and the mean operating time of 96 min (28-238 min); the SFR was 91 % (1.45 procedures/patient). The overall number of complications was 58 (8.6 %) of which 26 (4.5 %) were complications classed Clavien ≥ 3 (haematuria with subcapsular haematoma/clot retention-7; ureteral perforation-7; steinstrasse-5; sepsis/pyelonephritis-5; prostatitis-1; cerebrovascular accident-1). Ureterorenoscopy for large renal stones in the modern era has good SFR with a small risk of major complications.

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Section: Resultsmentioning

confidence: 99%

“…The age range was 18-86 years. Five of the studies were from the USA [9][10][11][12][13]16], the rest were individually from France [7], UK [8], Japan [12], India [14], Poland [15], Egypt [17] and Germany [18]. The included studies range from 1998-2013.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

et al. 2015

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“…In recent years, more and more doctors have been able to skillfully operate the flexible ureteroscope and determine the efficacy of ureteroscopy as an alternative to PCNL to tackle large renal stones. RIRS had an average stone-free rate of around 91-97.5% for stones >2 cm, with an average number of procedures of no more than two [5,30,31,32,33,34,35]. Takazawa et al [6] reported that in kidney stones 2-4 cm in size, after three procedures the stone-free rate was up to 100% with no major intraoperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, with the advances in ﬂexible ureteroscopic instrumentation and holmium laser lithotripsy, retrograde intrarenal surgery (RIRS) has become an increasingly considered option for intrarenal stone removal. Some studies [5,6] reported a stone-free rate near to 92% in patients with large stones. RIRS has been widely accepted in the management of larger renal stones as an alternative to PCNL.…”

Section: Introductionmentioning

confidence: 99%

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

et al. 2014

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Objective: To systematically review the efficacy and safety of retrograde intrarenal surgery (RIRS) versus percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi >2 cm. Methods: We searched PubMed, Cochrane Library, Embase and the Chinese Biomedical Literature Database about RIRS and PCNL for the treatment of renal stones. The retrieval time ended in December 2013. All clinical trials were retrieved and their included references investigated. Two reviewers independently assessed the quality of all included studies, and the eligible studies were included and analyzed using the RevMan 5.2 software. Results: Two randomized controlled trials and six clinical controlled trials were included, involving a total of 590 patients. Our meta-analysis showed that there were not significant differences in stone-free rate (relative risk [RR] = 0.95, 95% confidence interval (CI) 0.88-1.02, p = 0.11) and fever (RR = 0.95, 95% CI 0.54-1.67, p = 0.85) between RIRS and PCNL. We found that hospital stay (weighted mean difference [WMD] = -2.10, 95% CI -3.08 to -1.11, p < 0.10) and bleeding (RR = 0.20, 95% CI 0.06-0.68, p = 0.01) were lower and operation time was longer (WMD = 19.11, 95% CI 7.83-30.39, p < 0.10) for RIRS. Conclusion: RIRS is a safe and effective procedure. It can successfully treat patients with stones >2 cm with a high stone-free rate and significantly reduce hospital stay without increasing complications. RIRS can be used as an alternative treatment to PCNL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

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“…They included only patients who had a ureteral J-stent inserted preoperatively. Al-Qahtani et al [21] reported renal pelvis perforation in 1 of 120 patients. Minimal mucosal erosions or mucosal tears can be managed conservatively without inserting a ureteral J-stent (grade 1), but severe mucosal injuries as for example ureteral perforation are mostly treated by placing a ureteral J-stent (grade 2) successfully.…”

Section: Discussionmentioning

confidence: 99%

Categorizing Intraoperative Complications of Retrograde Intrarenal Surgery

Oğuz¹,

Reşorlu

Özyuvalı³

et al. 2014

Urol Int

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Purpose: To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). Patients and Methods: 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. Results: Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. Conclusion: In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons.

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Predictors of Clinical Outcomes of Flexible Ureterorenoscopy with Holmium Laser for Renal Stone Greater than 2 cm

Cited by 44 publications

References 26 publications

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

Categorizing Intraoperative Complications of Retrograde Intrarenal Surgery

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