Factors predicting stone-free rates after retrograde intrarenal surgery for lower pole kidney stones

Q3 Medicine

Canadian Urological Association Journal Pub Date : 2024-07-15 DOI:10.5489/cuaj.8807

Ryan Boudreau, Moustafa Fathy, Amr Hodhod, Rabail Siddiqui, Husain Alaradi, Saud Alhelal, Loay Abbas, Amer Alaref, A. Zakaria, H. Elmansy

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Abstract

Introduction: We aimed to investigate the factors impacting stone clearance following retrograde intrarenal surgery (RIRS) for lower pole kidney stones and to determine whether there is a significant relationship between the infundibular pelvic angle (IPA) of the kidney's lower pole and stone fragment clearance. Methods: We retrospectively reviewed patients who underwent flexible ureteroscopy (f-URS) for lower pole renal calculi between December 2020 and July 2023 at our institution. Patient demographics and stone parameters were recorded, including stone size, number, volume, density, and IPA. Intraoperative data, including total operative time, lasing time, type of laser used, and stone composition, were collected and analyzed. All patients underwent a computed tomography (CT) scan at three months followup. We recorded the presence of residual stones and the percentage of stone volume reduction. Patients with a stone size 3 mm were deemed stone-free. All patients were discharged home on the same operative day. Results: A total of 123 patients were included in the study: 71 in the stone-free group (group 1) and 52 in the residual stones group (group 2). On univariate analysis, there were significant differences between the two groups in terms of stone size, IPA, and the type of ureteroscopy used. At three months followup, 96% (24/25) of patients with an IPA <30° had residual stones, compared to 28.6% (28/98) of patients with an IPA >30° (p<0.001). There was no significant difference in the intraoperative or postoperative complications between the two groups. On multivariate analysis, IPA and stone size were the only predictive factors for the presence of residual stones. Twelve patients (23.1%) from group 2 required retreatment. Conclusions: RIRS is an effective treatment option for the management of lower pole kidney stones. IPA, in conjunction with stone size, appears to dictate the stone clearance rates of RIRS for lower pole stones.

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预测逆行肾内手术治疗下极肾结石后无结石率的因素

简介：我们旨在研究影响逆行肾内手术（RIRS）治疗下极肾结石后结石清除率的因素，并确定肾脏下极的肾盂内角（IPA）与结石碎片清除率之间是否存在显著关系：我们回顾性研究了2020年12月至2023年7月期间在我院接受柔性输尿管镜检查（f-URS）治疗下极肾结石的患者。我们记录了患者的人口统计学特征和结石参数，包括结石大小、数量、体积、密度和 IPA。收集并分析了术中数据，包括手术总时间、激光时间、使用的激光类型和结石成分。所有患者在随访三个月时都接受了计算机断层扫描（CT）。我们记录了是否存在残余结石以及结石体积缩小的百分比。结石大小为 3 毫米的患者被视为无结石。所有患者均在手术当天出院回家：共有123名患者参与了研究：结果：共有123名患者参与了研究：无结石组（第1组）71人，残余结石组（第2组）52人。经单变量分析，两组患者在结石大小、IPA和使用的输尿管镜类型方面存在显著差异。在三个月的随访中，96%（24/25）的患者的IPA为30°（P<0.001）。两组患者的术中或术后并发症没有明显差异。多变量分析显示，IPA和结石大小是出现残余结石的唯一预测因素。第二组中有 12 名患者（23.1%）需要再次治疗：RIRS是治疗下极肾结石的有效方法。IPA与结石大小似乎决定了RIRS治疗下极结石的结石清除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Urological Association Journal Medicine-Urology

CiteScore

2.10

自引率

0.00%

发文量

167

期刊介绍： Published by the Canadian Urological Association, the Canadian Urological Association Journal (CUAJ) released its first issue in March 2007, and was published four times that year under the guidance of founding editor (Editor Emeritus as of 2012), Dr. Laurence H. Klotz. In 2008, CUAJ became a bimonthly publication. As of 2013, articles have been published monthly, alternating between print and online-only versions (print issues are available in February, April, June, August, October, and December; online-only issues are produced in January, March, May, July, September, and November). In 2017, the journal launched an ahead-of-print publishing strategy, in which accepted manuscripts are published electronically on our website and cited on PubMed ahead of their official issue-based publication date. By significantly shortening the time to article availability, we offer our readers more flexibility in the way they engage with our content: as a continuous stream, or in a monthly “package,” or both. CUAJ covers a broad range of urological topics — oncology, pediatrics, transplantation, endourology, female urology, infertility, and more. We take pride in showcasing the work of some of Canada’s top investigators and providing our readers with the latest relevant evidence-based research, and on being the primary repository for major guidelines and other important practice recommendations. Our long-term vision is to become an essential destination for urology-based research, education, and advocacy for both physicians and patients, and to act as a springboard for discussions within the urologic community.