Lower Pole Stones Are Associated with Low Stone-Free Rates in Retrograde Intrarenal Surgery: A Myth or Fact? A Matched Case-Control Study from the RIRSearch Group.

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY Urologia Internationalis Pub Date : 2024-09-05 DOI:10.1159/000541253

Muhammed Fatih Simsekoglu, Oktay Özman, Hakan Cakir, Kerem Teke, Önder Çınar, Murat Akgül, Mustafa Bilal Tuna, Cem Başataç, Eyüp Burak Sancak, Duygu Sıddıkoğlu, Cenk Yazici, Barbaros Başeskioğlu, Haluk Akpinar, Bulent Onal

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Abstract

Introduction: There are conflicting results in the literature regarding the efficacy of Retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups.

Methods: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status one month after RIRS.

Results: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40-58) in Group 1 and 50 years (IQR: 35-60) in Group 2 (p=0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1-858.2) and 503.3 mm3 (IQR: 282.5-864), respectively (p=0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2 %) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p=0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p=0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p=0.393), and median operation time (60 min in both, p=0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 sec and 3 sec, respectively, p=0.013).

Conclusions: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones.

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逆行肾内手术中低极结石与低无结石率有关：神话还是事实？来自 RIRSearch 小组的一项匹配病例对照研究。

导言：关于逆行肾内手术（RIRS）对下极结石的疗效，文献中存在相互矛盾的结果。本研究旨在通过建立匹配的病例对照组，评估逆行肾内手术治疗下极结石的疗效：研究回顾性地纳入了 491 例确诊为肾结石并接受了 RIRS 的患者数据。在结石负荷、结石密度、术前双J支架状态和既往震波碎石史方面，按1:1的比例对209名下极结石患者（第1组）和282名肾盂结石患者（第2组）进行配对，每组159名患者。对无结石状态进行计算机断层扫描评估。主要结果是 RIRS 一个月后的无结石状态：病例对照匹配后，第一组患者的中位年龄为 49 岁（四分位间距 [IQR]：40-58），第二组患者的中位年龄为 50 岁（四分位间距 [IQR]：35-60）（P=0.388）。第 1 组和第 2 组的结石负荷中位值分别为 415.3 立方毫米（IQR：176.1-858.2）和 503.3 立方毫米（IQR：282.5-864）（P=0.100）。RIRS 后，第一组 159 名患者中有 126 人（79.2%）达到无结石状态，第二组 159 名患者中有 133 人（83.6%）达到无结石状态（P=0.387）。两组在围手术期并发症（第一组为 4.4%，第二组为 3.8%，P=0.777）、术后并发症（第一组为 13.8%，第二组为 10.3%，P=0.393）和中位手术时间（两组均为 60 分钟，P=0.230）方面相似。与第二组相比，第一组的中位透视时间更长（分别为26秒和3秒，P=0.013）：结论：RIRS术后，下极结石和盆腔结石患者的无结石率和并发症发生率相当。结论：RIRS术后下极结石和盆腔结石患者的无结石率和并发症发生率相当，但下极结石的透视时间较长。RIRS可有效治疗下极结石。

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

Urologia Internationalis 医学-泌尿学与肾脏学

CiteScore

3.30

自引率

6.20%

发文量

审稿时长

3-8 weeks

期刊介绍： Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.