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; Olivier Traxer; Deepak Ragoori; Andrea Benedetto Galosi; Virgilio De Stefano; Nariman Gadzhiev; Yiloren Tanidir; Takaaki Inoue; Esteban Emiliani; Saeed Bin Hamri; Mohamed Amine Lakmichi; Chandra Mohan Vaddi; Chin Tiong Heng; Boyke Soebhali; Sumit More; Vikram Sridharan; Mehmet Ilker Gökce; Azimdjon N Tursunkulov; Arvind Ganpule; Giacomo Maria Pirola; Angelo Naselli; Cemil Aydin; Fernando Ramón de Fata Chillón; Catalina Solano Mendoza; Luigi Candela; Ben Hall Chew; Bhaskar Kumar Somani; Vineet Gauhar

doi:10.1016/j.euros.2023.03.018

Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients

Eur Urol Open Sci. 2023 Apr 30:52:51-59. doi: 10.1016/j.euros.2023.03.018. eCollection 2023 Jun.

Authors

Daniele Castellani¹, Olivier Traxer², Deepak Ragoori³, Andrea Benedetto Galosi¹, Virgilio De Stefano¹, Nariman Gadzhiev⁴, Yiloren Tanidir⁵, Takaaki Inoue⁶, Esteban Emiliani⁷, Saeed Bin Hamri⁸, Mohamed Amine Lakmichi⁹, Chandra Mohan Vaddi¹⁰, Chin Tiong Heng¹¹, Boyke Soebhali¹², Sumit More¹³, Vikram Sridharan¹⁴, Mehmet Ilker Gökce¹⁵, Azimdjon N Tursunkulov¹⁶, Arvind Ganpule¹⁷, Giacomo Maria Pirola¹⁸, Angelo Naselli¹⁸, Cemil Aydin¹⁹, Fernando Ramón de Fata Chillón²⁰, Catalina Solano Mendoza^{2

21}, Luigi Candela^{2

22}, Ben Hall Chew²³, Bhaskar Kumar Somani²⁴, Vineet Gauhar¹¹

Affiliations

¹ Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
² Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France.
³ Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India.
⁴ Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia.
⁵ Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey.
⁶ Department of Urology, Hara Genitourinary Private Hospital, Kobe University, Kobe, Japan.
⁷ Department of Urology, Fundacion Puigvert, Autónomos University of Barcelona, Barcelona, Spain.
⁸ Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
⁹ Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco.
¹⁰ Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India.
¹¹ Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
¹² Department of Urology, Abdul Wahab Sjahranie Hospital, Medical Faculty Mulawarman University, Samarinda, Indonesia.
¹³ Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India.
¹⁴ Department of Urology, Sree Paduka Speciality Hospital, Thillai Nagar, India.
¹⁵ Department of Urology, Ankara University, School of Medicine, Ankara, Turkey.
¹⁶ Urology Division, AkfaMedline Hospital, Tashkent, Uzbekistan.
¹⁷ Department of Urology, Muļjibhai Patel Urological Hospital, Nadiad, Gujarat, India.
¹⁸ Urology Department, San Giuseppe Hospital, IRCCS Multimedica, Multimedica Group, Milan, Italy.
¹⁹ Department of Urology, Hitit University, School of Medicine, Çorum, Turkey.
²⁰ Department of Urology, Clinica Universidad de Navarra, Madrid, Spain.
²¹ Department of Endourology, Uroclin S.A.S, Medellín, Colombia.
²² Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy.
²³ Department of Urology, University of British Columbia, Vancouver, Canada.
²⁴ Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK.

Abstract

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.

Keywords: Flexible ureteroscopy; Holmium laser; Kidney calculi; Laser; Lithotripsy; Retrograde intrarenal surgery; Thulium fiber laser.