Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract

Abstract

Treatment of large and multiple stones located in the ureter and/or the kidney may be challenging. The aim of the current study was to evaluate the results and complications of retrograde endoscopic lithotripsy for stones located in the urinary tract and to determine prognostic factors for treatment outcome. From April 2017 to March 2020, eligible patients for the active treatment of ureterolithiasis with or without concomitant nephrolithiasis <20 mm were enrolled in the study. The prognostic factors for the stone free rate (SFR) after the 1st and subsequent sessions and overall complications were assessed. Patients were divided into single or multiple lithiasis groups (groups A and B respectively). A comparison between these two groups was then conducted. Overall, 237 stones were detected in 155 patients, representing a mean burden of 1.53 stone per patient. The mean total stone size was 14.7 mm, the initial SFR was 80% and the final SFR (after a mean of 1.23 session per patient) was 94.2%. The rate of complications was 26.4%. Multivariative analysis revealed that preoperative stenting and total stone size were independent prognostic factors of initial SFR, while no independent factors were determined for final SFR. Age, total size and stones in the lower calyx were independent factors for complications. In group A and B, 114 and 41 cases with solitary and multiple stones were included, respectively. Excluding operation time (P= 0.002), no significant differences were recorded in terms of initial (P= 0.255) and final SFR (P= 0.056), hospital stay (P=0.308), mean number of treatments (P=0.757) and the rate of complications (P=0.218) between the two groups. In conclusion, retrograde endoscopic management of multiple lithiasis has a favorable outcome irrespective of stone location. Older patients with higher burdens and stones in the lower calyx should be treated with caution.

Comparison of flexible ureteroscopy in the treatment of 1–2 cm single nephrolithiasis and multiple nephrolithiasis

“…Our study found that the operative time in the multiple stones group was significantly longer than that in the solitary stone group, which seems logical: more stones obviously require more time. DIOMIDIS et al showed that the operative time for RIRS was 57.5 min (42 min–90 min) for solitary stone and 88 min (55 min–105 min) for multiple stones, which is consistent with our study ( 16 ). However, in their study, semi-rigid ureteroscopy was used to treat solitary calculi, which were all ureteral calculi.…”

“…In addition, it was concluded that stone length was an independent risk factor for SFR rather than stone number and location (16), which is similar to our findings. There was no significant difference in SFR between the single stone group and the multiple stone group in our study.…”

“…However, some studies have found that compared with stone density, stone length is an independent risk factor for predicting postoperative complications ( 24 ). Similar results were reported by Kozyrakis D et al, who found that stone density was not an independent risk factor for postoperative complications or SFR, but stone length was ( 16 ). In addition, the holmium laser has been the gold standard for laser lithotripsy for decades, and any type of stone can be treated.…”

Perioperative and long-term results of ultrasonography-guided single- and multiple-tract percutaneous nephrolithotomy for staghorn calculi

“…Compared with the younger population, older patients appeared to be more vulnerable. The aging urinary tract system as well as an increased volume of the prostate in male patients may contribute to the development of lower urinary tract symptomatology, infections, and fever in older patients following surgery[ 28 ].…”

Comparison of flexible ureteroscopy and mini-percutaneous nephrolithotomy in the treatment for multiple nephrolithiasis

“…However, there are many studies on the prognostic factors of stone removal surgery. Kozyrakis D et al found that neither the number nor location of stones had a significant effect on the outcome of lithotripsy (19), so physicians should not discourage the use of f-URS in patients with multiple kidney stones. Studies showing that the number of stones affects the outcome of surgery are mostly focusing on SWL (20).…”