Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Retrograde Intrarenal Surgery Outcomes in the Management of Renal Stones: A Retrospective Analysis of 3,781 Cases Over 11 Years
11 Yıllık Sürede 3.781 Vakanın Retrospektif Analizi: Böbrek Taşlarının Tedavisinde Retrograd İntrarenal Cerrahi Sonuçları
Ali NEBİOĞLUa , Mert BAŞARANOĞLUb , Mesut TEKb , Erdem AKBAYb
aMersin City Training and Research Hospital, Clinic of Urology, Mersin, Türkiye
bMersin University Faculty of Medicine Health Application and Research Center, Department of Urology, Mersin, Türkiye
J Reconstr Urol. 2025;15(2):44-51
doi: 10.5336/urology.2025-108940
Article Language: EN
Full Text
ABSTRACT
 Objective: To evaluate the efficacy, safety, and clinical outcomes of retrograde intrarenal surgery in a large patient cohort and identify factors affecting treatment success across different demographic groups. Material and Methods: This retrospective study analyzed 3,781 patients who underwent retrograde intrarenal surgery between January 2013 and December 2023. Patient demographics, stone characteristics, operative parameters, and complications were evaluated. Stone-free rates, operative times, and complications were assessed according to stone location and size. The primary outcome was stone-free status evaluated by non-contrast computed tomography at 3 months postoperatively. Multivariate analysis was performed to identify predictors of treatment success. Results: The overall stonefree rate was 88.7%. Mean stone size was 13.9±5.6 mm, with mean operative time of 52 minutes. Stone distribution was: lower calyx (42.5%), renal pelvis (30.0%), upper calyx (15.2%), and middle calyx (12.3%). Total complication rate was 12.5%, with minor complications (ClavienDindo Grade I-II) occurring in 11.4%, moderate complications (Grade III) in 1.0%, and major complications (Grade IV) in 0.05% of cases. Multivariate analysis identified stone size >15mm (odds ratio [OR]: 0.68, p<0.001), lower calyx location (OR: 0.75, p=0.004), and multiple stones (OR: 0.82, p=0.042) as significant predictors of treatment success. Patient satisfaction averaged 8.4 out of 10, showing strong correlation with stone-free status (correlation coefficient: 0.85, p<0.001). Conclusion: Retrograde intrarenal surgery demonstrates high efficacy and safety in treating upper urinary tract stones, with favorable outcomes across different patient groups. Stone size, location, and multiplicity significantly influence treatment success, while complication rates remain low with standardized technique. These findings can aid in optimizing patient selection and improving preoperative counseling.

Keywords: Ureteroscopy; urinary calculi; minimally invasive surgical procedures; treatment outcome; postoperative complications
ÖZET
 Amaç: Geniş hasta kohortunda retrograd intrarenal cerrahinin etkinliğini, güvenliğini ve klinik sonuçlarını değerlendirmek ve farklı demografik gruplarda tedavi başarısını etkileyen faktörleri belirlemek. Gereç ve Yöntemler: Bu retrospektif çalışma, Ocak 2013-Aralık 2023 tarihleri arasında retrograd intrarenal cerrahi uygulanan 3.781 hastayı analiz etti. Hasta demografisi, taş özellikleri, operatif parametreler ve komplikasyonlar değerlendirildi. Taş lokasyonu ve boyutuna göre taşsızlık oranları, operasyon süreleri ve komplikasyonlar değerlendirildi. Birincil sonuç, postoperatif 3. ayda kontrastsız bilgisayarlı tomografi ile değerlendirilen taşsızlık durumuydu. Tedavi başarısının öngördürücülerini belirlemek için çok değişkenli analiz yapıldı. Bulgular: Genel taşsızlık oranı %88,7 idi. Ortalama taş boyutu 13,9±5,6 mm, ortalama operasyon süresi 52 dakika idi. Taş dağılımı şu şekildeydi: alt kaliks (%42,5), renal pelvis (%30,0), üst kaliks (%15,2) ve orta kaliks (%12,3). Toplam komplikasyon oranı %12,5 olup; minör komplikasyonlar (Clavien-Dindo Grade I-II) %11,4, orta komplikasyonlar (Grade III) %1,0 ve majör komplikasyonlar (Grade IV) %0,05 oranında görüldü. Çok değişkenli analiz, 15 mm'den büyük taş boyutu (odds ratio [OR]: 0,68, p<0,001), alt kaliks lokalizasyonu (OR: 0,75, p=0,004) ve multipl taşları (OR: 0,82, p=0,042) tedavi başarısının anlamlı öngördürücüleri olarak belirledi. Hasta memnuniyeti 10 üzerinden ortalama 8,4 olup, taşsızlık durumu ile güçlü korelasyon gösterdi (korelasyon katsayısı: 0,85, p<0,001). Sonuç: Retrograd intrarenal cerrahi, üst üriner sistem taşlarının tedavisinde yüksek etkinlik ve güvenlik göstererek farklı hasta gruplarında olumlu sonuçlar sağlamaktadır. Taş boyutu, lokalizasyonu ve multiplisitesi tedavi başarısını önemli ölçüde etkilemekte, standardize teknik ile komplikasyon oranları düşük kalmaktadır. Bu bulgular hasta seçiminin optimizasyonuna ve preoperatif danışmanlığın iyileştirilmesine yardımcı olabilir.

Anahtar Kelimeler: Üreterorenoskopi; üriner kalkülüsler; minimal invaziv cerrahi işlemler; tedavi sonucu; postoperatif komplikasyonlar
REFERENCES:
  1. Sorokin I, Mamoulakis C, Miyazawa K, Rodgers A, Talati J, Lotan Y. Epidemiology of stone disease across the world. World J Urol. 2017;35(9):1301-20. [PubMed] 
  2. Zeng G, Mai Z, Xia S, Wang Z, Zhang K, Wang L, et al. Prevalence of kidney stones in China: an ultrasonography based cross-sectional study. BJU Int. 2017;120(1):109-16. [PubMed] 
  3. Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003;63(5):1817-23. [PubMed] 
  4. Ferraro PM, D'Addessi A, Gambaro G. When to suspect a genetic disorder in a patient with renal stones, and why. Nephrol Dial Transplant. 2013;28(4):811-20. [PubMed] 
  5. Scales CD Jr, Smith AC, Hanley JM, Saigal CS; Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160-5. [PubMed]  [PMC] 
  6. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69(3):468-74. [PubMed] 
  7. Desai MM, Aron M, Gill IS, Pascal-Haber G, Ukimura O, Kaouk JH, et al. Flexible robotic retrograde renoscopy: description of novel robotic device and preliminary laboratory experience. Urology. 2008;72(1):42-6. [Crossref]  [PubMed] 
  8. Autorino R, Zargar H, Kaouk JH. Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil Steril. 2014;102(4):939-49. [Crossref]  [PubMed] 
  9. Breda A, Territo A, López-Martínez JM. Benefits and risks of ureteral access sheaths for retrograde renal access. Curr Opin Urol. 2016;26(1):70-5. [PubMed] 
  10. De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015;67(1):125-37. Erratum in: Eur Urol. 2016;69(4):e85. [Crossref]  [PubMed] 
  11. Türk C, Petrik A, Neisius A, Seitz C, Skolarikos A, Thomas K. Guidelines on urolithiasis. European Association of Urology. 2018:273-305. [Link] 
  12. Breda A, Angerri O. Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol. 2014;24(2):179-83. [PubMed] 
  13. Emiliani E, Subiela JD, Regis F, Angerri O, Palou J. Over 30-yr Experience on the Management of Graft Stones After Renal Transplantation. Eur Urol Focus. 2018;4(2):169-74. [Crossref]  [PubMed] 
  14. Ferraro PM, Curhan GC, D'Addessi A, Gambaro G. Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol. 2017;30(2):227-33. [PubMed] 
  15. Daudon M, Dessombz A, Frochot V, Letavernier E, Haymann JP, Jungers P, et al. Comprehensive morpho-constitutional analysis of urinary stones improves etiological diagnosis and therapeutic strategy of nephrolithiasis. C R Chim. 2016;19(11-12):1470-91. [Crossref] 
  16. Tailly T, Nadeau BR, Violette PD, Bao Y, Amann J, Nott L, et al. Stone Burden Measurement by 3D Reconstruction on Noncontrast Computed Tomography Is Not a More Accurate Predictor of Stone-Free Rate After Percutaneous Nephrolithotomy Than 2D Stone Burden Measurements. J Endourol. 2020;34(5):550-7. [Crossref]  [PubMed] 
  17. Proietti S, Giusti G, Desai M, Ganpule AP. A Critical Review of Miniaturised Percutaneous Nephrolithotomy: Is Smaller Better? Eur Urol Focus. 2017;3(1):56-61. [Crossref]  [PubMed] 
  18. Somani BK, Robertson A, Kata SG. Decreasing the cost of flexible ureterorenoscopic procedures. Urology. 2011;78(3):528-30. [PubMed] 
  19. Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B, de la Rosette J. Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones in the CROES URS Global Study. J Urol. 2015;194(1):137-43. [PubMed] 
  20. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189(2):580-4. [Crossref]  [PubMed] 

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