The Feasibility and Outcomes of Retrograde Intrarenal Surgery to Treat Staghorn Renal Calculi

Objective: To study the safety and efficacy of retrograde intrarenal surgery (RIRS) in patients with staghorn stones. Materials and Methods: This retrospective observational study was carried out between May 2016 and October 2020, which is when we performed RIRS in staghorn stone patients. Medical records of all patients with this condition in the database of Siriraj Hospital were reviewed. A total of 35 patients were eligible for this study. Descriptive statistics were used to assess the safety and efficacy of RIRS in patients with staghorn stones. Results: In total, 31.43% of patients were stone-free after the first round of RIRS and 59.55% achieved stone-free status after the second procedure. The stone-free rate did not increase after a second round of RIRS. The median size of all staghorn stones was 3.1 cm. Unfortunately, we found two sepsis patients in this study. We also found eight events of minor complications, including fever and minimal ureteric injury in 54 sessions of RIRS we performed. However, no major injuries or bleeding requiring blood transfusion was identified. Conclusion: Percutaneous nephrolithotomy (PCNL) is still considered the first-line therapy for kidney stones over two centimeters with a favorable stone-free rate. But, in some patients with limitations such as uncorrectable coagulopathies, impaired renal function, single kidney, and morbid obesity, RIRS is a good choice to reduce the likelihood of serious complications and have an acceptable stone-free rate. However, a prospective study should be performed to confirm these findings.