Investig Clin Urol.  2016 Jul;57(4):274-279. 10.4111/icu.2016.57.4.274.

Is it necessary to actively remove stone fragments during retrograde intrarenal surgery?

• Lee YJ
• Bak DJ
• Chung JW
• Lee JN
• Kim HT
• Yoo ES
• Kim BS

• KMID: 2426505
• DOI: http://doi.org/10.4111/icu.2016.57.4.274

Abstract

PURPOSE
Based on the experiences of our center, we sought to verify the necessity of actively removing stones during retrograde intrarenal surgery (RIRS) for the management of renal stones.
MATERIALS AND METHODS
From March 2010 to March 2015, 248 patients underwent RIRS at our center. We classified these patients into 2 groups according to the performance of active stone removal; group A (n=172) included the patients whose stones were actively removed using a stone basket, and group B (n=76) included the patients whose stones were fragmented with laser lithotripsy without active removal of the fragments. We retrospectively compared the operation time, success rate, and complication rate between the 2 groups.
RESULTS
There were no significant differences between groups A and B in terms of mean age (56.1 years vs. 58.6 years), male to female ratio (115:57 vs. 46:30), mean body mass index (24.5 kg/m² vs. 25.0 kg/m²), mean preoperative size of stone (11.1 mm vs. 11.1 mm), the ratio of unilateral and bilateral stones (136:36 vs. 64:12), success rate (89.0% vs. 86.8%), operation time (82.5 minutes vs. 82.1 minutes), overall complication rate (9.9% vs. 11.8%), incidence of febrile urinary tract infection (6.4% vs. 2.6%), gross hematuria (1.7% vs. 2.6%), or postoperative de novo hydronephrosis (2.9% vs. 5.3%).
CONCLUSIONS
This study demonstrated that during RIRS, fragmentation only, without the active removal of stones, is a safe and effective technique in which the surgical outcomes are comparable to those of procedures involving the active removal of stones.

Keyword

Kidney calculi; Lasers; Lithotripsy; Ureteroscopy

MeSH Terms

Adult
Aged
Female
Hematuria/etiology
Humans
Intraoperative Care/methods
Kidney Calculi/diagnosis/pathology/*therapy
Lithotripsy, Laser/adverse effects/*methods
Male
Middle Aged
Operative Time
Postoperative Complications
Retrospective Studies
Ureteroscopy/adverse effects/*methods
Urinary Tract Infections/etiology

Figure

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  Fig. 1 An endoscopic image of active removal of stone using stone basket during retrograde intrarenal surgery.

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  Fig. 2 Endoscopic images of 'dusting' using laser lithotritor during retrograde intrarenal surgery.

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