Publicaciones científicas
Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients
Daniele Castellani 1 , Olivier Traxer 2 , Deepak Ragoori 3 , Andrea Benedetto Galosi 1 , Virgilio De Stefano 1 , Nariman Gadzhiev 4 , Yiloren Tanidir 5 , Takaaki Inoue 6 , Esteban Emiliani 7 , Saeed Bin Hamri 8 , Mohamed Amine Lakmichi 9 , Chandra Mohan Vaddi 10 , Chin Tiong Heng 11 , Boyke Soebhali 12 , Sumit More 13 , Vikram Sridharan 14 , Mehmet Ilker Gökce 15 , Azimdjon N Tursunkulov 16 , Arvind Ganpule 17 , Giacomo Maria Pirola 18 , Angelo Naselli 18 , Cemil Aydin 19 , Fernando Ramón de Fata Chillón 20 , Catalina Solano Mendoza 2 21 , Luigi Candela 2 22 , Ben Hall Chew 23 , Bhaskar Kumar Somani 24 , Vineet Gauhar 11
Background: Bilateral kidney stones are commonly treated in staged procedures.
Objective: To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones.
Design setting and participants: Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo.
Outcome measurements and statistical analysis: Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR.
Results and limitations: A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis.
Conclusions: SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones.
Patient summary: In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.
CITA DEL ARTÍCULO Eur Urol Open Sci. 2023 Apr 30:52:51-59. doi: 10.1016/j.euros.2023.03.018
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