逆行性軟式輸尿管鏡腎內手術治療腎結石之安全與療效成果：單一醫學中心之經驗

何岩¹、蕭志豪^1,2、李良明¹、溫玉清^1,2、林雍偉^1,2、林克勳¹、許軒豪¹、賴宗豪¹、鍾卓興¹

臺北市立萬芳醫院-委託財團法人臺北醫學大學辦理 泌尿科¹

臺北醫學大學醫學院醫學系 泌尿學科²

Safety and Efficacy Outcomes of Retrograde Intrarenal Surgery (RIRS) for Renal Stones: A Single-Center Experience

Yen Ho¹, Chi-Hao Hsiao^1,2, Liang-Ming Lee¹, Yu-Ching Wen^1,2, Yung-Wei Lin^1,2, Ke-Hsun Lin¹, Syuan-Hao Syu¹, Benjamin Lai Chung Howe¹, Cho-Hsing Chung¹

Department of Urology, Taipei Municipal Wan Fang Hospital¹

Department of Urology, School of Medicine, College of Medicine, Taipei Medical University²

Purpose: Retrograde intrarenal surgery (RIRS) has widely been accepted as one of the primary alternative treatment options for renal stones and other specific circumstances. We aimed to evaluate the efficacy and safety outcomes of RIRS carried out on patients with renal stones or tumors at our institution over a 5-year period.

Materials and Methods: A retrospective review was conducted of the medical records of patients who underwent RIRS at a tertiary care center between December 2019 and October 2022. Prior to the operation, thorough examinations including laboratory and radiological investigations were performed. High stone complexity was defined as stones located in more than one major calyces or being larger than 2cm. We reported the demographic characteristics, clinical features, and complications associated with treatment. Perioperative complications were classified using the modified Clavien–Dindo classification system.

Results: One hundred and eighty-seven patients were identified (123 (66%) male, 64 (34%) female) undergoing RIRS with mean age of 60.8±13.1years. Nineteen patients (10%) received the procedure for non-urolithiasis reasons. Among the urolithiasis patients(n=168), high stone complexity was found in 82 patients (49%) with increasing prevalence over time. Stones located in lower calyces were seen in 106 patients (63.1%). The sizes of the stones in the largest dimension ranged from 0.3 to 5.1cm with the mean value of 1.3cm. Mean operative time was 120.5±59.1 minutes. Mean length-of-stay was 1.4 days postoperatively and 2.7 days in total. Stone-free status was achieved in 127 patients (75.6%). Even though the procedure seemed to have lower stone-free rates(SFR) for patients with larger stones, our SFR for patients with stones smaller than 2.6cm is 80%. Seventeen patients (9.1%) had grade 1 to 2 complications with 4 patients having postoperative fever. Six patients (3.2%) had grade 3 to 4 complications, including five patients experiencing ureteral stricture that required additional surgical interventions and one patient having postoperative septic shock that required administration of vasoactive agents.

Conclusions: Our study showed outcomes compatible with those reported in the previous literature including stone-free rates, operative time, length-of-stay and complication rates. In addition, efficacy outcomes improved over time with consistent complication rates in our institution. To be specific, patients with renal stones smaller than 2.6cm may have preferable treatment outcomes undergoing RIRS.