Effect of prior diverse surgical histories on the efficacy and safety of one-stage retrograde intrarenal surgery in patients with renal stone: a retrospective study.

Abstract

Purpose: To investigate the influence of a history of percutaneous nephrolithotomy (PCNL) and a history of retrograde intrarenal surgery (RIRS) on the efficacy and safety of one-stage RIRS in patients with renal stones.

Methods: A retrospective analysis was conducted on the clinical data of 115 patients with renal stones who underwent one-stage RIRS from January 2022 to June 2025. These patients were divided into three groups: group A (with a history of PCNL) comprising 28 cases, group B (with a history of RIRS) comprising 37 cases, and group C (without a history of urinary stone surgery) comprising 50 cases. The operative time, postoperative hospital stay, postoperative increase in serum creatinine levels, complication rate, and stone-free rate (SFR) at 1 week and 4 weeks postoperatively were compared among the three groups. Linear regression was employed to identify independent predictors of operative time, while logistic regression was used to analyze independent factors influencing the stone-free rate at 4 weeks postoperatively and the occurrence of complications.

Results: All patients in the three groups successfully completed the surgery. The operative time in group A was (61.5 ± 8.9) min, which was significantly longer than that in group B [(53.4 ± 6.3) min] and group C [(51.0 ± 6.7) min] (P < 0.01). There were no significant differences in the postoperative hospital stay among group A [(2.2 ± 0.8) d], group B [(2.2 ± 0.7) d], and group C [(2.1 ± 0.3) d] (P>0.05). No significant differences were observed in the postoperative increase in serum creatinine levels among group A [(12.23 ± 8.68) μmol/L], Group B [(13.34 ± 9.11) μmol/L], and group C [(12.16 ± 8.38) μmol/L] (P > 0.05). The complication rate was 7.1% in group A, with no significant differences compared to 8.1% in group B and 8.0% in group C (P > 0.05). At 1 week postoperatively, the SFR was 64.2% in group A, with no significant differences compared to 62.2% in group B and 66.0% in group C (P>0.05); at 4 weeks postoperatively, the SFR was 85.7% in group A, with no significant differences compared to 89.2% in group B and 90.0% in group C (P >0.05). Multivariate logistic regression analysis demonstrated that a history of urinary stone surgery was not an independent influencing factor for the SFR at 4 weeks postoperatively or the occurrence of complications (P>0.05).

Conclusion: A history of PCNL may prolong the operative time of one-stage RIRS, but it has no significant impact on the SFR or complication rate. A history of RIRS has no significant effect on the operative time, stone-free rate, or postoperative complication rate of one-stage RIRS. For patients with renal stones who have previously undergone PCNL or RIRS, one-stage RIRS represents an effective and safe treatment option.