影響逆行性腎臟內視鏡結石手術的併發症和結石廓清率的因素

鄭鼎耀¹、林祖鋒¹、陳建志¹、邱文祥^1,2、陳鈺昕¹

台北馬偕紀念醫院 ¹泌尿科；²國立陽明交通大學醫學院

Optimizing Outcomes in Retrograde Intrarenal Surgery for Stones: Factors Affecting Postoperative Complications and Stone-Free Rates

Ting-Yao Cheng¹, Tsu-Feng Lin¹, Marcelo Chen¹, Allen W. Chiu^1,2, Yu-Hsin Chen¹

Department of Urology, MacKay Memorial Hospital, Taipei, Taiwan¹; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan ²

Purpose: The aim of this study was to investigate the factors that contribute to postoperative complications and the rate of achieving a stone-free state in patients who underwent retrograde intrarenal surgery (RIRS) for the treatment of stones.

Materials and Methods: We conducted a retrospective review of patients who underwent RIRS for stones at our institution between January 2019 and December 2021. Patient demographics, including age, gender, medical comorbidities, body mass indices, perioperative parameters, and stone-related factors were collected. Postoperative complications were defined as operation-related adverse events and all-cause mortality occurring within 30 days after surgery. Stone-free status was determined based on imaging conducted approximately 4-6 weeks after double-J stent removal. Uni- and multi-variate analyses were used to identify factors associated with postoperative complications and stone-free rates.

Results: A total of 187 patients (251 kidney units) met the study criteria. The mean age was 57.2 years, and the average cumulative stone size was 27.8±16.9 mm. The mean operative time was 104.3±53 minutes, and the overall stone-free rate was 61%. Postoperative complications occurred in 26 patients (13.9%), with two deaths resulting from surgery-induced sepsis and aspiration pneumonia. Multivariate analysis revealed that recent ipsilateral stone intervention (OR 0.23, p=0.013) was associated with a lower risk of complications following RIRS. In addition, lower cumulative stone size (OR 1.06, p<0.001) and higher BMI (OR=1.12, p=0.03) were significantly associated with achieving a stone-free state.

Conclusions: Recent intervention for ipsilateral stones prior to RIRS may be a protective factor against postoperative complications. Lower stone burden is associated with higher stone-free rates, while higher stone-free rates in obese patients may be misleading due to difficulty in detecting residual stones during follow-up.