Outcomes and safety of retrograde intra-renal surgery for renal stones less than 2 cm in size

Retrograde intra-renal surgery [RIRS] has been used to remove stones of less than 2 cm in the kidney. However, its role is not well defined. The objective of this study was to evaluate the outcomes and safety of RIRS, used either as a primary or secondary procedure, and to analyze factors predicting the stone-free rate [SFR]. A retrospective analysis was performed on data from patients who underwent RIRS over a 10-year period [2002-2012]. Stone size was measured as the surface area and was calculated according to the EAU guidelines. In cases of multiple stones, the total stone burden was calculated as the sum of each stone size. Stone burden was then classified as < 80 mm[2] or > 80 mm[2]. RIRS was classified as primary procedure or secondary procedure [after failed extracorporeal shockwave lithotripsy or percutaneous nephrolith-otripsy]. Stone clearance was defined as a complete absence of stones or stones < 4 mm, which were deemed insignificant on ultrasonography and plain radiography. Results: The overall SFR for renal stones treated with RIRS in our center was 55.4%, and the complication rate was 1.5%, which consisted of one case of sepsis. The only factor affecting SFR in this study was the indication for RIRS. When performed as a primary operation, RIRS showed a significantly better SFR [643%]. The SFR for lower pole stones was only 44.4%. There were no statistically significant effects of stone burden, radio-opacity, or combination with ureteral stones on SFR. Conclusions: RIRS should be used as the primary treatment for renal stones whenever possible

Iatrogenic Ureter Injuries: Eleven Years Experience in A Tertiary Hospital

Iatrogenic ureteric injuries are rare complications of abdomino-pelvic surgery but associated with high morbidity from infection and possible loss of renal function. A successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair. In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis