Staged Retrograde Endoscopic Lithotripsy as Alternative to PCNL in Select Patients with Large Renal Calculi

Ricchiuti, Daniel; Smaldone, Marc C.; Jacobs, Bruce L.; Smaldone, Arlene; Jackman, Stephen V.; Averch, Timothy D.

doi:10.1089/end.2007.9871

Cited by 52 publications

(40 citation statements)

References 18 publications

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“…We achieved total stone-free rate of 79.2 and 92.4% after single and second stage procedures, respectively. These results are comparable to similarly previously published series for RIRS with ureterorenoscopy [9,11,12,[16][17][18][19][20][21].…”

Section: Discussionsupporting

confidence: 91%

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Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

et al. 2011

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The management of renal calculi following previous open surgery represents a challenge for urologists. The aim of this study is to evaluate the outcomes and safety of ureteroscopic laser retrograde intrarenal surgery (RIRS) for renal calculi following prior open renal surgery. The charts of 53 patients who underwent RIRS for renal calculi following prior open surgery for urolithiasis were reviewed. Both flexible and semi-rigid ureteroscopes were utilized together with holmium: YAG laser for stone disintegration. Intravenous urography, computed tomography (CT) and ultrasound were used to evaluate the patient, perioperatively. Stone size ranged from 5 to 32 mm (mean 14.3 mm). The mean operative time was 86 min (20-130). The overall stone-free rate was 92.4%. The overall stone-free rates after one and two-procedures were 79.2% (42 cases) and 92.4% (49 cases), respectively. Four patients (7.5%) had larger residual fragments, 2 (3.8%) of them underwent SWL, and 2 (3.8%) cases were followed up conservatively. Major complications were reported in two patients (3.8%). Stone analysis revealed calcium oxalate in 39 patients, uric acid in 5, calcium phosphate in 4, struvite in 3, and cystine in 2 cases. Ureteroscopic retrograde intrarenal surgery for renal calculi following prior open renal surgery was a minimally invasive, safe procedure with a high success rate. It is a viable alternative for PNL in managing recurrent renal calculi efficiently.

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Section: Discussionsupporting

confidence: 91%

“…The overall complication rate of ureteroscopy, which is reported in recent literature lies between 6 and 23% [9,11,12,[17][18][19][20][21][22][23][24]. In our study, the overall complication rate was 20.7%.…”

Section: Discussionsupporting

confidence: 53%

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

et al. 2011

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“…[43][44][45][46][47][48][49][50][51][52] Most of the studies included are of small patient cohorts; only three studies included >100 patients. 46,50,51 Data from these studies [43][44][45][46][47][48][49][50][51][52] clearly indicate that the likelihood of being stonefree after a single procedure is low. The overall SFR after the first flexible URS (residual fragments ≤4 mm to zero fragments), in the seven studies that report this measure was 56.8% (range 23-74%), 44,45,[47][48][49][50]52 and the mean number of procedures was 1.6 (range 1.1-2.3).…”

Section: Stone Sizementioning

confidence: 99%

What is the stone-free rate following flexible ureteroscopy for kidney stones?

2015

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Flexible ureteroscopy (URS) is increasingly being used as the first-line treatment for patients with renal stones. Despite this increase in use, substantial variations exist in the reported stone-free rates (SFR) following flexible URS. These variations are a result of inconsistencies in the definition of 'stone-free', which reflect variations in the type of imaging used to assess the presence of stones postoperatively and the timing of the assessment. Other possible factors such as the importance of residual fragments following stone surgery, and the size and position of the stones might also account for variations in stone-free rates. In order to obtain an accurate estimate of the SFR, especially within subgroups defined by stone characteristics and exact technique, we compare reported SFRs from studies that use imaging other than CT for follow-up and those that use only CT. We also review the evidence on the importance of active retrieval of fragments during flexible URS and whether this technique improves the outcomes of patients with kidney stones.

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“…[10] They stratified the locations within the kidney with the stone free rate for lower pole and locations other than the lower pole which was 83% and 74% respectively, showing that the lower pole stones had a better stone free rate. The linear calculated diameter was inversely propositional to the stone free rate (10-20 mm-100%, 20-30 mm-87.5%, 30-40 mm-60%, >40 mm-40%)…”

Section: Discussionmentioning

confidence: 99%

Retrograde ureteroscopic intrarenal surgery for large (1.6-3.5 cm) upper ureteric/renal calculus

Prabhakar¹

2010

Indian J Urol

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Objective:To assess the feasibility of retrograde ureteroscopic intrarenal surgery (RIRS) as a viable alternate to percutaneous nephrostolithotripsy (PCNL) in treating patients with renal and upper ureteric calculus of 1.6 cm to 3.5 cm stone burden.Materials and Methods:From October 2007 to November 2008, a total of 30 cases of upper ureteric and renal stone of 1.6 cm to 3.5 cm (Average size 2.5 cm) stone burden, for which PCNL would be done otherwise, were treated by RIRS with combined flexible and semi rigid ureteroscope and stones fragmented with holmium laser. The patients were discharged after 24 hours of the procedure and allowed to resume normal work after two days. X ray KUB for radio opaque stones and ultrasound for all the cases were done after three weeks and if any residual fragments of any size were present the patient was taken up for re-look flexible ureteroscopy under anesthesia. Stent and residual fragments were removed. If there was no residue the stent was removed under local anesthesia.Results:Complete clearance was considered if there were no fragments on USG screening after three weeks. Twenty six (86.6%) patients out of 30 had complete clearance in the first sitting and 4 (13.3%) patients needed re-look flexible ureteroscopy. The stone free rate in RIRS is 86.6% in the first sitting and 100% at second sitting.Conclusion:RIRS is superior in terms of less complication, less morbidity and good stone free rate and has an advantage of one day of hospital stay and resuming duties after two days. RIRS is the best option for managing extracorporeal shockwave lithotripsy failed and post PCNL residual calculus. RIRS is definitely a viable alternate for PCNL for upper tract stones up to 3.5 cm.

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Staged Retrograde Endoscopic Lithotripsy as Alternative to PCNL in Select Patients with Large Renal Calculi

Abstract: Percutaneous methods of managing renal stones have an increased rate of complications compared with ureteroscopy. In patients with complex medical histories, upper urinary tract calculi <4 cm can be safely and effectively managed using a staged retrograde endoscopic approach.

Cited by 52 publications

References 18 publications

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

Ureteroscopic retrograde intrarenal surgery after previous open renal stone surgery: initial experience

What is the stone-free rate following flexible ureteroscopy for kidney stones?

Retrograde ureteroscopic intrarenal surgery for large (1.6-3.5 cm) upper ureteric/renal calculus

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