The Effect of Stone Composition on the Efficacy of Retrograde Intrarenal Surgery: Kidney Stones 1–3 cm in Diameter

Xue, Yuquan; Zhang, Peng; Yang, Xiaojie; Chong, Tie

doi:10.1089/end.2014.0778

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…These findings indicate that, not only stone size, but also stone hardness plays a major role in determining the surgical outcomes of FURS in the treatment of renal stones. This is in keeping with previous report by Xue et al [9] In their study, the authors performed stone analyses. They reported 52.9% stone clearance rate for FURS in the treatment of stones of >2 cm with harder composition versus 72.7% clearance rate for easy to crush-stones of >2 cm.…”

Section: Discussionsupporting

confidence: 90%

“…[7,8] However, Xue et al [9] has proved that stone composition is another important factor in predicting the outcome of FURS in patients with renal stones, especially that laser is the only energy source that can be used during FURS for stone fragmentation. Calcium phosphate, and calcium oxalate monohydrate stones are more demanding in terms of time and energy source used for fragmentation when compared with uric acid, and magnesium-ammonium-phosphate stones.…”

Section: Discussionmentioning

confidence: 99%

“…[9] Calcium phosphate, and calcium oxalate monohydrate stones are the hardest to disintegrate. [10] Hardness of the renal stones can be assessed by non-contrast computed tomography (NCCT).…”

Section: Introductionmentioning

confidence: 99%

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Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?"

Hamed

Elmoghazy

Mohamed

et al. 2017

Turkish Journal of Urology

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Objective: To evaluate the stone hardness in predicting the need for single or two sessions of retrograde intrarenal surgery (RIRS) for renal pelvis stones of 2-3 cm in size. Material and methods:Ninety-six patients (64 male and 32 female) with only renal stones (2.5±0.3 cm) underwent RIRS using flexible 7.5 Fr ureteroscope (FURS). The stone hardness was evaluated by preoperative non-contrast computed tomography (NCCT). The patients were divided into two groups based on stone hardness: Group I (n=54) (hard stones -Hounsfield Unit (HU) >1000) and group II (n=42) (not hard stone -HU <1000). The stone-free rate, the operative time, any intra or postoperative complications and the need for second sessions of RIRS were evaluated.Results: All stones were successfully accessed. Intraoperative complications were not reported. The initial stone-free rate was 40% in Group I and 95% in Group II after a single session (p= 0.01). A second session FURS was needed in 32 cases of Group I (40%) where postoperative CT showed significant residual stone fragments of 6±2 mm, and stone-free rate up to 100 percent. On the contrary only 2 cases from Group II underwent second session FURS (p= 0.01). The operative times were 75±15 minutes in Group I and 55±13 minutes in Group II (p<0.01). Six patients (4 in group I and 2 in group II) had postoperative high-grade fever (Clavien Grade II). Conclusion:Stone hardness had a significant impact on the decision of performing single versus two sessions of FURS for renal pelvic stones of 2-3 cm rather than the stone size alone.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?"

Hamed

Elmoghazy

Mohamed

et al. 2017

Turkish Journal of Urology

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“…Although holmium laser can be used for every type of stone, the fragmentation time is variable. Xue et al [1] retrospectively evaluated the results of RIRS performed in 74 patients with stones ranging from 1 cm to 3 cm. Calcium oxalate monohydrate and calcium phosphate stones were found to be fragmented slower than calcium oxalate dehydrate, magnesium ammonium phosphate and uric acid stones, where this finding was especially significant in stones larger than 2 cm.…”

Section: Effect Of Stone Composition On Rirsmentioning

confidence: 99%

Retrograde intrarenal surgery for renal stones - Part 2

Kılıç

Akand

2017

Turkish Journal of Urology

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Retrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature.

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“…Among these factors, the characteristics of the stone are very crucial. Several articles documented that the composition or Hounsfield units (HU) of the stone have a great impact on the efficacy of fURS (7,8). However, HU based on computed tomography (CT) only represents the average value of the stone and thus cannot reflect the intracalculi structure, which is eminently related to the SFR.…”

Section: Introductionmentioning

confidence: 99%

A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

et al. 2020

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The purpose of the study is to develop and validate a novel clinical-radiomics nomogram model for pre-operatively predicting the stone-free rate of flexible ureteroscopy (fURS) in kidney stone patients. Patients and Methods: Altogether, 2,129 fURS cases with kidney stones were retrospectively analyzed, and 264 patients with a solitary kidney stone were included in a further study. For lower calyx calculi, a radiomics model was generated in a primary cohort of 99 patients who underwent non-contrast-enhanced computed tomography (NCCT). Radiomics feature selection and signature building were conducted by using the least absolute shrinkage and selection operator (LASSO) method. Multivariate logistic regression analysis was employed to build a model incorporating radiomics and potential clinical factors. Model performance was evaluated by its discrimination, calibration, and clinical utility. The model was internally validated in 43 patients. Results: The overall success rate of fURS was 72%, while the stone-free rate (SFR) for lower calyx calculi and non-lower calyx calculi was 56.3 and 90.16%, respectively. On multivariate logistic regression analysis of the primary cohort, independent predictors for SFR were radiomics signature, stone volume, operator experience, and hydronephrosis level, which were all selected into the nomogram. The area under the curve (AUC) of clinical-radiomics model was 0.949 and 0.947 in the primary and validation cohorts, respectively. Moreover, the calibration curve showed a satisfactory predictive accuracy, and the decision curve analysis indicated that the nomogram has superior clinical application value. Conclusion: In this novel clinical-radiomics model, the radiomics scores, stone volume, hydronephrosis level, and operator experience were crucial for the flexible ureteroscopy strategy.

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The Effect of Stone Composition on the Efficacy of Retrograde Intrarenal Surgery: Kidney Stones 1–3 cm in Diameter

Cited by 15 publications

References 18 publications

Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?"

Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?"

Retrograde intrarenal surgery for renal stones - Part 2

A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

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