Prediction of Possible Factors that Affect Stone Free Rate of Retrograde Intrarenal Surgery; A Multicenter Study

Yıl 2020, Cilt: 8 Sayı: 3, 398 - 403, 20.12.2020

Oktay Özman , Cem Başataç , Murat Akgül , Önder Çınar , Eyüp Burak Sancak , Cenk Murat Yazıcı , Bulent Onal , Haluk Akpınar

https://doi.org/10.37696/nkmj.729445

Öz

Objective: The aim of the study was to evaluate possible factors predicting stone-free status at retrograde intrarenal surgery for renal stones.
Material and Method: A retrospective multicenter study was performed using data from 513 patients treated between February 2016 and January 2020 at four referral centers in Turkey. The patients were divided into two groups whether they had no residual stone over 3 mm (Group 1) or not (Group 2). Pre and peroperative parameters were compared in both groups (Table 1). Univariate and multivariate analyzes were performed to identify any factors affecting the stone-free rate (Table 2).
Results: Overall stone-free rate was 88.5% (454/513). Lower calyx stones and multipl stones were significantly higher in Group 2 (p=0.006, p=0.02, respectively). Also access sheathless procedure rate was significantly higher and the basket catheter useage rate was significantly lower in Group 2 (p=0.04, p<0.00001, respectively) (Table 1). Multiple stone presence and basket catheter usage during the procedure were found as independent factors to predict the stone-free status of Retrograde Intrarenal Surgery according to the results of logistic regression analysis (95%CI 3.3577-0.9999; H-L p= 0.05 and 95%CI 0.4442-0.1290; H-L p= 0.00001, respectively) (Table 2).
Conclusion(s): The presence of multiple stones in preoperative imaging and the use of basket catheters peroperatively are independent factors predicting stone-free status in Retrograde Intrarenal Surgery. The presence of multiple stones increases the probability of residual stones after the procedure, while the use of basket catheters is to reduce this possibility.

Anahtar Kelimeler

Kidney stone, Retrograde Intrarenal Surgery

Retrograd İntrarenal Cerrahi’de Taşsızlığı Öngören Faktörler; Çok Merkezli Bir Çalışma

Öz

Amaç: Bu çalışmanın amacı Retrograd İntrarenal Cerrahi’de taşsızlığı öngören olası faktörleri araştırmaktır.
Materyal ve Metod: Şubat 2016-Ocak 2020 tarihleri arasında Türkiye'deki dört ayrı merkezde tedavi edilen 513 hastanın verileri kullanılarak retrospektif çok merkezli bir çalışma gerçekleştirildi. Hastalar 3 mm'nin üzerinde rezidü taş saptananlar (Grup 1) ve rezidü taş saptanmayanlar (Grup 2) olmak üzere iki gruba ayırıldı. Pre ve peroperatif parametreler her iki grupta karşılaştırıldı (Tablo 1). Taşsızlık oranını etkileyen faktörleri araştırmak için univariate ve multivariate analizler yapıldı (Tablo 2).
Bulgular: Toplam taşsızlık oranı % 88.5 idi (454/513). Alt kaliks taşları ve multipl taşlar Grup 2'de anlamlı olarak daha yüksekti (sırasıyla p = 0.006, p = 0.02). Ayrıca erişim kılıfsız prosedür oranı Grup 2'de anlamlı olarak yüksek ve basket kateter kullanım oranı anlamlı olarak düşüktü (sırasıyla p = 0.04, p <0.00001) (Tablo 1). İşlem sırasında çoklu taş varlığı ve basket kateter kullanımı lojistik regresyon analizi sonuçlarına göre Retrograd İntrarenal Cerrahi’de taşsızlığı öngörmede bağımsız faktörler olarak bulundu (% 95 CI 3.3577-0.9999; HL p = 0.05 ve% 95 CI 0.4442-0.1290; HL p = 0.00001) (Tablo 2).
Sonuç(lar): Ameliyat öncesi görüntülemede çoklu taş varlığı ve basket kateterlerin peroperatif olarak kullanılması Retrograd İntrarenal Cerrahi’de taşsızlık durumunu öngören bağımsız faktörlerdir. Multipl taş varlığı işlemden sonra rezidü taş olasılığını arttırırken, basket kateterlerinin kullanımı bu olasılığı azaltmaktır.

Anahtar Kelimeler

böbrek taşı, retrograd intrarenal cerrahi

Kaynakça

• 1. Sanguedolce F, Bozzini G, Chew B, Kallidonis P, de la Rosette J. The Evolving Role of Retrograde Intrarenal Surgery in the Treatment of Urolithiasis. Eur Urol Focus. 2017 Feb;3(1):46-55. doi: 10.1016/j.euf.2017.04.007. Epub 2017 May 5.
• 2. Karsiyakali N, Karabay E, Erkan E, Kadihasanoglu M. Evaluation of Nephrolithometric Scoring Systems to Predict Outcomes of Retrograde Intrarenal Surgery. Urol J. 2020 Jan 4. doi: 10.22037/uj.v0i0.5256. [Epub ahead of print]
• 3. Kang SK, Cho KS, Kang DH, Jung HD, Kwon JK, Lee JY. Systematic review and meta-analysis to compare success rates of retrograde intrarenal surgery versus percutaneous nephrolithotomy for renal stones >2 cm: An update. Medicine (Baltimore). 2017 Dec;96(49):e9119. doi: 10.1097/MD.0000000000009119.
• 4. Zhang Y, Wu Y, Li J, Zhang G. Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Treatment of Lower Calyceal Calculi of 2-3 cm in Patients With Solitary Kidney. Urology. 2018 May;115:65-70. doi: 10.1016/j.urology.2017.11.063. Epub 2018 Feb 22.
• 5. Garg S, Mandal AK, Singh SK et al (2009) Ureteroscopic laser lithotripsy versus ballistic lithotripsy for treatment of ureteric stones: a prospective comparative study. Urol Int 82(3):341–345
• 6. Demir A, Karadağ MA, Ceçen K, Uslu M, Arslan OE. Pneumatic versus laser ureteroscopic lithotripsy: a comparison of initial outcomes and cost.Int Urol Nephrol. 2014 Nov;46(11):2087-93. doi: 10.1007/s11255-014-0787-x. Epub 2014 Aug 1.
• 7. Hatanaka Y, Yasuda M, Saitou Y, Imanishi M. [Efficacy of a basket catheter used in transurethral lithotripsy]. Hinyokika Kiyo. 2013 May;59(5):283-5. Japanese.
• 8. Johnson GB, Portela D, Grasso M.Advanced ureteroscopy: wireless and sheathless. J Endourol. 2006 Aug;20(8):552-5.
• 9. Çimen Hİ, Halis F, Sağlam HS, Gökçe A. Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones.Turk J Urol. 2017 Sep;43(3):309-312. doi: 10.5152/tud.2017.24638. Epub 2017 Jul 31.
• 10. Ibrahim A, Elhilali MM, Fahmy N, Carrier S, Andonian S. Double-Blind Prospective Randomized Clinical Trial Comparing Regular and Moses Mode of Holmium Laser Lithotripsy. J Endourol. 2020 Mar 6. doi: 10.1089/end.2019.0695. [Epub ahead of print]
• 11. Huang J, Zhao Z, AlSmadi JK, Liang X, Zhong F, Zeng T et al. Use of the ureteral access sheath during ureteroscopy: A systematic review and meta-analysis. PLoS One. 2018 Feb 28;13(2):e0193600. doi: 10.1371/journal.pone.0193600. eCollection 2018.
• 12. Stern KL, Loftus CJ, Doizi S, Traxer O, Monga M. A Prospective Study Analyzing the Association Between High-grade Ureteral Access Sheath Injuries and the Formation of Ureteral Strictures. Urology. 2019 Jun;128:38-41. doi: 10.1016/j.urology.2019.02.032. Epub 2019 Mar 14.