Efficacy and Safety of Holmium Laser Lithotripsy for Renal Calculi in Retrograde Intrarenal Surgery: A Comparative Study in Libyan Patients

Background Kidney stones are a common problem that can be treated by different surgical methods. The choice of treatment depends on the stone and patient characteristics and the local resources and skills of the urologists. Aim The aim of this study was to evaluate the outcomes regarding the safety and effectiveness of retrograde intrarenal surgery (RIRS) using holmium laser lithotripsy for kidney stones sizes of less than or equal to 20, and more than 20 mm. Methods The study was conducted on 54 patients with renal calculi at a single center using RIRS and holmium lithotripsy from April 2022 to April 2023. Stone size was calculated by summing up the diameters of all renal calculi, and stone-free rate (SFR) was defined as no stone or stone fragment less than 1 mm in the kidney. Results are described as mean ± standard deviation, frequency, and percentages. Chi-squared or unpaired t-tests are used for comparison between different groups as appropriate. A p-value less than 0.05 is considered significant. Results The mean intrarenal stone size was 17.8 ± 7.6 mm, with a significant difference in stone size less than or equal to 20 mm and stone size more than 20 mm (19 ± 4.7 and 35 ± 4 mm, respectively). The main operation time was 66 ± 36.5 minutes, with significantly longer operation time for patients with kidney stones more than 20 mm (94.9 ± 34.5 vs. 49 ± 26 for stone size ≤20 mm). There was no difference in the length of stay after operation between the two different stone sizes. The overall immediate SFR was 64.4%, where stone size less than or equal to 20 mm showed a significantly higher SFR (83%) than SFR for stone size more than 20 mm (31%). This SFR increased to 91.1% 1 month later, with 100% clearance for stones size less than or equal to 20 mm compared with only 68% for stones size more than 20 mm. The overall complication rate was 9.2%, most of them were due to urinary tract infections (5 cases) that required intravenous antibiotics. Stone size had no significant effect on the complication rate. There was no significant difference in SFR between lower calyceal stone and other sites of stone. Conclusion RIRS combined with holmium laser lithotripsy is a valuable treatment option for patients with renal stones particularly for patients with stones size of less than or equal to 20 mm with a relatively low rate and severity of complications.