Research Article
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Our experience of retrograde intrarenal surgery in the treatment of upper urinary tract stones

Year 2021, Volume: 13 Issue: 1, 23 - 28, 31.01.2021

Abstract

Objective: The purpose of this study was to evaluate results for patients with renal or proximal ureter stone disease and undergoing retrograde intrarenal surgery (RIRS).


Material and Methods
: Demographic, clinical, operative and postoperative datas from 99 patients who underwent RIRS for upper urinary tract stones between March 2019 and May 2020 were analyzed retrospectively. Non-contrast computed tomography (CT) was routinely performed on all patients. Stone location and size were assessed using CT. Achieving stone-free status or residual stone size ≤ 2 mm were regarded as operational success.

Results: RIRS was performed on 99 patients, 60 (60.6%) men and 39 (39.4%) women, with a mean age of 44.9 ± 13.1 years (range, 20 - 74). RIRS was applied to the right unit in 48 patients and to the left in 50. The procedure was performed on both sides in the same session in one case. The stone was in the kidney in 78 patients and in the proximal ureter in 21. The mean stone burden was 18.5 ± 6.9 mm (range, 7 - 35), and the mean operative time was 70.6 ± 23.8 minutes (range, 40 - 125). All patients were discharged on the first postoperative day. No complications occurred during surgery or the postoperative period. The stone free rate was 90.8%.


Conclusion:
We believe that the RIRS procedure is a minimally invasive technique that can be used instead of percutaneous nephrolithotomy as experience increases and technology advances.

References

  • 1. Tefekli A, Tok A, Altundere F, et al. Lifestyle and nutritional habits in urinary stone patients. Turk J Urol 2005;31:113-8.
  • 2. Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016;69:475–482.
  • 3. Ünsal A, Reşorlu B. Retrograd İntrarenal Cerrahi. Endoüroloji Bülteni 2014;7:147-151.
  • 4. Karakose A, Aydogdu O, Atesci YZ. The use of the amplatz sheath in percutaneous nephrolithotomy: does amplatz sheath size matter? Curr Urol 2013;7:127-131.
  • 5. Wendt-Nordahl G, Mut T, Krombach P, et al. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011;39:185-188.
  • 6. Binbay M, Yuruk E, Akman T, et al. Is there a difference in outcomes between digital and fiber optic flexible ureterorenoscopy procedures? J Endourol 2010;24:1929-34.
  • 7. Geraghty R, Abourmarzouk O, Rai B, et al. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era. Curr Urol Rep 2015;16(8):54.
  • 8. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol 2001;40:362-71.
  • 9. Pearle MS , Lingeman JE, Leveillee R, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower polecaliceal calculi 1 cm or less. J Urol 2005;173:2005-9.
  • 10. Karakose A, Aydogdu O, Atesci YZ. Does the Use of Smaller Amplatz Sheath Size Reduce Complication Rates in Percutaneous Nephrolithotomy? J Urol 2014;11:1752-6.
  • 11. Lingeman JE, Coury TA, Newman DM, et al. Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 1987;138:485-90.
  • 12. Seitz C , Desai M, Häcker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2012;61:146-58.
  • 13. Karakose A, Atesci YZ, Aydogdu O. The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication? Can Urol Assoc J 2014;8:3-4.
  • 14. Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology 2008;71:214-7.
  • 15. Assimos A, Crisci A, Culkin D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int 2016;117:648-54.
  • 16. Karakose A, Yüksel MB. Üreteroskopik üriner taş hastalığı cerrahisinde malzemelerin tekrar kullanımının işlem maliyetine etkisinin analizi. Yeni Üroloji Dergisi 2012;7:21-25.
  • 17. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol 2007;52:1610.
  • 18. Geavlete P,Georgescu D, Niţă G, et al. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006;20:179.
  • 19. Castro PE, Osther PJS, Jinga V et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 2014;66:102.
  • 20. Serter S, Sahin E, Yildirim UM, et al. Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone. Clin Invest Med 2016;39:27518.
  • 21. Baran Ö, Atan A, Aykaç A, et al. Üst üriner sistem taşlarında taş büyüklüğüne göre fleksibl üreterorenoskopinin etkinliği. Yeni Üroloji Dergisi 2016;11(3):20-27.
  • 22. Yalçın S, Karşıyakalı N, Kaya E, et al. Alt Pol Böbrek Taşlarının Tedavisinde Şok Dalga Litotripsi ve Retrograd İntrarenal Cerrahi Etkinliğinin Karşılaştırılması: Tek Merkez, Vaka Kontrol Çalışması. Yeni Üroloji Dergisi 2020;15(2):127-134.
  • 23. Tokas T, Skolarikos A, Herrmann TRW, et al. Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 2019;37:125-131.
  • 24. Karakose A, Alp T, Güner ND, et al. Genel üroloji pratiğimizde androlojik olguların yeri. Turk J Urol 2010;36:49-54.
  • 25. Tokas T, Skolarikos A, Herrmann TRW, et al. Pressure matters 2: intrarenal pressure ranges during upper tract endourological procedures. World J Urol 2019;37:133–42.

Üst üriner sistem taşları tedavisinde retrograd intrarenal cerrahi deneyimlerimiz

Year 2021, Volume: 13 Issue: 1, 23 - 28, 31.01.2021

Abstract

Amaç: Bu çalışmada böbrek veya proksimal üreter taşı nedeniyle retrograd intrarenal cerrahi (RİRC) uyguladığımız hastaların sonuçlarını değerlendirmeyi amaçladık.


Gereç ve Yöntemler
: Mart 2019 ile Mayıs 2020 tarihleri arasında böbrek ve proksimal üreter taşlarına yönelik RİRC uygulanan 99 hastanın demografik, klinik, operatif ve postoperatif verileri retrospektif olarak değerlendirildi. Tüm hastalara kontrastsız bilgisayarlı tomografi yapılarak taş lokalizasyonu ve taş boyutu değerlendirildi. Postoperatif kontrolde, radyolojik olarak taş olmaması veya 2 mm ve altı fragmanlar taşsızlık olarak kabul edildi.

Bulgular: Çalışmaya yaş ortalaması 44,9 ± 13,1 yıl (20 - 74) olan toplam 99 hasta alındı. Hastaların 60’ı (60,6%) erkek ve 39’u (39,4%) kadındı. 48 (%48,4) hastaya sağ, 50 (%50,5) hastaya sol ve bir (%1,1) hastaya bilateral RİRC operasyonu yapıldı. 78 (% 78,8) hastanın taşı böbrekte iken, 21 (% 21,2) hastanın taşı proksimal üreterdeydi. Ortalama taş büyüklüğü 18,5 ± 6,9 mm (7 - 35) ve ortalama ameliyat süresi 70,6 ± 23,8 dakika (40 - 125) olarak bulundu. Ameliyat sırasında ve sonrasında hastalarda majör bir komplikasyon gelişmedi. Toplam 90 hastada taşsızlık sağlandı ve genel başarı oranımız % 90,9 olarak bulundu.


Sonuç
: Gelişen teknoloji ve artan deneyim ile birlikte RİRC üst üriner sistem taşlarının tedavisinde düşük komplikasyon ve yüksek taşsızlık oranları ile oldukça başarılı bir tedavi yöntemi olduğunu düşünmekteyiz.

References

  • 1. Tefekli A, Tok A, Altundere F, et al. Lifestyle and nutritional habits in urinary stone patients. Turk J Urol 2005;31:113-8.
  • 2. Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol 2016;69:475–482.
  • 3. Ünsal A, Reşorlu B. Retrograd İntrarenal Cerrahi. Endoüroloji Bülteni 2014;7:147-151.
  • 4. Karakose A, Aydogdu O, Atesci YZ. The use of the amplatz sheath in percutaneous nephrolithotomy: does amplatz sheath size matter? Curr Urol 2013;7:127-131.
  • 5. Wendt-Nordahl G, Mut T, Krombach P, et al. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011;39:185-188.
  • 6. Binbay M, Yuruk E, Akman T, et al. Is there a difference in outcomes between digital and fiber optic flexible ureterorenoscopy procedures? J Endourol 2010;24:1929-34.
  • 7. Geraghty R, Abourmarzouk O, Rai B, et al. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era. Curr Urol Rep 2015;16(8):54.
  • 8. Tiselius HG, Ackermann D, Alken P, et al. Guidelines on urolithiasis. Eur Urol 2001;40:362-71.
  • 9. Pearle MS , Lingeman JE, Leveillee R, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower polecaliceal calculi 1 cm or less. J Urol 2005;173:2005-9.
  • 10. Karakose A, Aydogdu O, Atesci YZ. Does the Use of Smaller Amplatz Sheath Size Reduce Complication Rates in Percutaneous Nephrolithotomy? J Urol 2014;11:1752-6.
  • 11. Lingeman JE, Coury TA, Newman DM, et al. Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 1987;138:485-90.
  • 12. Seitz C , Desai M, Häcker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 2012;61:146-58.
  • 13. Karakose A, Atesci YZ, Aydogdu O. The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication? Can Urol Assoc J 2014;8:3-4.
  • 14. Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology 2008;71:214-7.
  • 15. Assimos A, Crisci A, Culkin D, et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int 2016;117:648-54.
  • 16. Karakose A, Yüksel MB. Üreteroskopik üriner taş hastalığı cerrahisinde malzemelerin tekrar kullanımının işlem maliyetine etkisinin analizi. Yeni Üroloji Dergisi 2012;7:21-25.
  • 17. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. Eur Urol 2007;52:1610.
  • 18. Geavlete P,Georgescu D, Niţă G, et al. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006;20:179.
  • 19. Castro PE, Osther PJS, Jinga V et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 2014;66:102.
  • 20. Serter S, Sahin E, Yildirim UM, et al. Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone. Clin Invest Med 2016;39:27518.
  • 21. Baran Ö, Atan A, Aykaç A, et al. Üst üriner sistem taşlarında taş büyüklüğüne göre fleksibl üreterorenoskopinin etkinliği. Yeni Üroloji Dergisi 2016;11(3):20-27.
  • 22. Yalçın S, Karşıyakalı N, Kaya E, et al. Alt Pol Böbrek Taşlarının Tedavisinde Şok Dalga Litotripsi ve Retrograd İntrarenal Cerrahi Etkinliğinin Karşılaştırılması: Tek Merkez, Vaka Kontrol Çalışması. Yeni Üroloji Dergisi 2020;15(2):127-134.
  • 23. Tokas T, Skolarikos A, Herrmann TRW, et al. Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 2019;37:125-131.
  • 24. Karakose A, Alp T, Güner ND, et al. Genel üroloji pratiğimizde androlojik olguların yeri. Turk J Urol 2010;36:49-54.
  • 25. Tokas T, Skolarikos A, Herrmann TRW, et al. Pressure matters 2: intrarenal pressure ranges during upper tract endourological procedures. World J Urol 2019;37:133–42.
There are 25 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Research Articles
Authors

Yasin Yitgin 0000-0003-1111-6941

Ayhan Karaköse 0000-0003-3905-1772

Ekrem Akdeniz 0000-0002-0666-9579

Publication Date January 31, 2021
Published in Issue Year 2021 Volume: 13 Issue: 1

Cite

Vancouver Yitgin Y, Karaköse A, Akdeniz E. Our experience of retrograde intrarenal surgery in the treatment of upper urinary tract stones. Endourol Bull. 2021;13(1):23-8.