To determine surgical outcomes and stone-free rates (SFRs) when offering upfront retrograde intrarenal surgery (RIRS) to patients with asymptomatic incidental renal stones (AIRS), as active surveillance, shockwave lithotripsy or upfront intervention in patients with AIRS is still a debate among urologists.
This retrospective FLEXible Ureteroscopy Outcomes Registry (FLEXOR), supported by the Team of Worldwide Endourological Researchers (TOWER), examines adult patients who underwent RIRS. We analysed a subset of asymptomatic patients with renal stones on imaging who were treated with RIRS. Data includes patient characteristics, stone specifications, anaesthesia type, perioperative details, complications, and SFR. A multivariable logistic regression analysis was performed to assess factors associated with the SFR.
Among 679 patients with AIRS, 640 met the inclusion criteria. The median age was 55 years, with 33.4% being female. In all, 22.1% had positive urine cultures. The median stone diameter was 12 mm, commonly in lower and interpolar locations. RIRS was preferentially performed under general anaesthesia using a reusable scope in 443 cases. Prophylactic antibiotics were administered to 314 patients. The median operation time was 58 min and the median laser time was 24 min. The SFR was 68.8%. The use of holmium laser (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.06-0.63; P < 0.01) and multiple stones (OR 0.38, 95% CI 0.19-0.76; P < 0.01) were factors associated with lower odds of being stone free. Overall complications were minimal, with sepsis in 1.6% of patients. Re-interventions were performed in 76 cases (11.8%), with RIRS being the most common in 67 cases (10.6%).
Our multicentre real-world study is the first of its kind that highlights the pros and cons of offering RIRS to patients with AIRS and demonstrates a favourable SFR with acceptable complications. Pre-emptively discussing potential re-intervention helps patients make informed decisions, particularly in cases involving large and multiple stones.
BJU international. 2024 Feb 11 [Epub ahead of print]
William Lay Keat Ong, Bhaskar Kumar Somani, Khi Yung Fong, Jeremy Yuen-Chun Teoh, Kemal Sarica, Chu Ann Chai, Deepak Ragoori, Thomas Tailly, Saeed Bin Hamri, Chin Tiong Heng, Sarvajit Biligere, Esteban Emiliani, Nariman Gadzhiev, Yiloren Tanidir, Ben Hall Chew, Daniele Castellani, Oliver Traxer, Vineet Gauhar, from The FLEXible Ureteroscopy Outcomes Registry (FLEXOR)
Department of Urology, Penang General Hospital, Penang, Malaysia., Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK., Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., S. H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Biruni University Medical School, Istanbul, Turkey., Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia., Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India., Department of Urology, ERN eUROGEN Accredited Centre, University Hospital of Ghent, Ghent, Belgium., 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., Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore., Urology Department, Universidad Autónoma de Barcelona, Fundación Puigvert Barcelona, Barcelona, Spain., Department of Urology, Endourology Academy, Istanbul, Turkey., Department of Urology, Marmara University School of Medicine, Istanbul, Turkey., Department of Urology, University of British Columbia, Vancouver, Canada., Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy., Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France.