Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?

Can J Urol. 2014 Apr;21(2):7207-12.

Abstract

Introduction: Major kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.

Materials and methods: By retrospective analysis, we identified a total of 162 patients who were affected by stones greater than 2 cm in diameter and who had undergone RIRS. We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications.

Results: The mean stone size was 2.7 cm +/- 0.6 cm. The primary, secondary, and tertiary stone-free rates were 66%, 80.9%, and 87.7%, respectively. The mean number of procedures per patient was 1.48. The complication rates according to the Clavien-Dindo classification were Clavien I in 20.4% of patients, Clavien II in 0%, Clavien III in 4.9%, Clavien IV in 0.6%, and Clavien V in 0%.

Conclusions: As an alternative to standard procedures for the treatment of renal calculi greater than 2 cm in diameter, RIRS is safe and effective, with a low complication rate.

MeSH terms

  • Adult
  • Aged
  • Endoscopy / adverse effects*
  • Endoscopy / methods
  • Female
  • Humans
  • Kidney Calculi / classification
  • Kidney Calculi / pathology*
  • Kidney Calculi / surgery*
  • Lithotripsy, Laser / adverse effects
  • Lithotripsy, Laser / methods
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / methods
  • Retrospective Studies
  • Treatment Outcome
  • Ureteroscopy
  • Urologic Surgical Procedures / adverse effects*
  • Urologic Surgical Procedures / methods