The authors declare that they have no competing interests.
Conceived and designed the experiments: DHL. Performed the experiments: DHL, XL, YZH. Analyzed the data: DHL, MLC. Contributed reagents/materials/analysis tools: DHL, MLC. Wrote the paper: DHL, MLC. All authors read and approved the final manuscript.
Ipsilateral asymptomatic renal stone associated with symptomatic ureteral stone is not a rare event, and the recommended treatment policy was not declared clearly. This study was conducted to compare the outcomes of simultaneous retrograde intrarenal surgery (RIRS) and ureteroscopy to ureteroscopy alone for this clinical event.
415 patients with symptomatic ureteral stone and ipsilateral asymptomatic renal stones were reviewed to obtain two match groups, who were treating with simultaneous modality (group A, N = 72), or ureteroscopy alone (group B, N = 72). Matching criteria were ureteral and renal stone side, duration and location, the presence of pre-stented. Perioperative and postoperative characteristics were compared between the two groups.
Mean stone burdens were similar between group A and B. Mean operative duration for group A and B were 72.4 ± 21.3 and 36.4 ± 10.2 min, respectively (P < 0.001). Mean hospital duration was 6.4 ± 2.9 and 5.3 ± 2.1 days in group A and B, respectively (P = 0.521). Ureteral SFR was 100% in each group. Renal SFR for RIRS was 86.1%. Complication rates in group A were higher (22.2% vs 13.9%), but the differences were not statistically significant (P = 0.358). In group A, complications were significantly less in pre-stented patients (3/25 vs 5/11, P = 0.04). Auxiliary treatment rate was significant higher in group B (69.4% vs 5.6%, P < 0.001) during follow-up (mean >18 months).
Simultaneous RIRS for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal can be performed safely and effectively. It promises a high SFR with lower auxiliary treatment rate, and does not lengthen hospital duration and increase complications.
Keeley Jr FX, Tilling K, Elves A, Menezes P, Wills M, Rao N, et al. Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones. BJU Int. 2001;87(1):1–8. PubMed
Turk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C. Guidelines on urolithiasis. 2012. p. 1–102. Available at: http://www.uroweb.org/gls/pdf/20_Urolithiasis.pdf.
Koh LT, Ng FC, Ng KK. Outcomes of long-term follow-up of patients with conservative management of asymptomatic renal calculi. BJU Int. 2012;109(4):622–5. PubMed
Sabnis RB, Jagtap J, Mishra S, Desai M. Treating renal calculi 1-2 cm in diameter with minipercutaneous or retrograde intrarenal surgery: a prospective comparative study. BJU Int. 2012;110(8 Pt B):E346–9. PubMed
Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR. Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int. 2013;112(3):355–61. PubMed
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, et al. Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol. 2013;31(6):1581–6. PubMed
Ozturk U, Sener NC, Goktug HN, Nalbant I, Gucuk A, Imamoglu MA. Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10-20 mm. Urol Int. 2013;91(3):345–9. PubMed
Ho CC, Hafidzul J, Praveen S, Goh EH, Bong JJ, Lee BC, et al. Retrograde intrarenal surgery for renal stones smaller than 2 cm. Singapore Med J. 2010;51(6):512–5. PubMed
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev. 2009;7(4):CD007044.
Kanao K, Nakashima J, Nakagawa K, Asakura H, Miyajima A, Oya M, et al. Preoperative nomograms for predicting stone-free rate after extracorporeal shock wave lithotripsy. J Urol. 2006;176(4 Pt 1):1453–6. PubMed
Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones--amultivariate analysis model. Scand J Urol Nephrol. 2004;38(2):161–7. PubMed
Galvin DJ, Pearle MS. The contemporary management of renal and ureteric calculi. BJU Int. 2006;98(6):1283–8. PubMed
Sarkissian C, Noble M, Li J, Monga M. Patient decision making for asymptomatic renal calculi: balancing benefit and risk. Urology. 2013;81(2):236–40. PubMed
Goldberg H, Holland R, Tal R, Lask DM, Livne PM, Lifshitz DA. The impact ofretrograde intrarenal surgery for asymptomatic renal stones in patients undergoing ureteroscopy for a symptomatic ureteral stone. J Endourol. 2013;27(8):970–3. PubMed
Grasso M, Ficazzola M. Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol. 1999;162(6):1904–8. PubMed
Resorlu B, Oguz U, Resorlu EB, Oztuna D, Unsal A. The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology. 2012;79(1):61–6. PubMed
Riley JM, Stearman L, Troxel S. Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol. 2009;23(9):1395–8. PubMed
Streem SB, Yost A, Mascha E. Clinical implications of clinically insignificant store fragments after extracorporeal shock wave lithotripsy. J Urol. 1996;155:1186. PubMed
Glowacki LS, Beecroft ML, Cook RJ, Pahl D, Churchill DN. The natural history of asymptomatic urolithiasis. J Urol. 1992;147(2):319–21. PubMed
Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol. 2007;21(2):119–23. PubMed
Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser Doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol. 2002;16(8):583–90. PubMed
Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189(2):580–4. PubMed
Monga M, Best S, Venkatesh R, Ames C, Lee C, Kuskowski M, et al. Durability of flexible ureteroscopes: a randomized, prospective study. J Urol. 2006;176(1):137–41. PubMed
Binbay M, Yuruk E, Akman T, Ozgor F, Seyrek M, Ozkuvanci U, et al. Is there a difference in outcomes between digital and fiberoptic flexible ureterorenoscopy procedures? J Endourol. 2010;24(12):1929–34. PubMed
Multescu R, Geavlete B, Georgescu D, Geavlete P. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: a critical comparison. J Endourol. 2010;24(1):17–21. PubMed
Karaolides T, Bach C, Kachrilas S, Goyal A, Masood J, Buchholz N. Improving the durability of digital flexible ureteroscopes. Urology. 2013;81(4):717–22. PubMed
- Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal
- BioMed Central
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