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INTRODUCTION: To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age groups. METHODS: Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in Group 1, Group 2, Group 3, and Group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, peroperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups. RESULTS: A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in Group 1, 324 (46.5%) in Group 2, 217 (31.1%) in Group 3, and 87 (12.5%) in Group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, peroperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p=0.001). The postoperative complication rates were significantly higher in Group 1 with Clavien I-II complication predominance (p=0.003). CONCLUSION: The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients.
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INTRODUCTION: The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden. MATERIAL AND METHODS: Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS. RESULTS: The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates (p<.001, p<.001, p=.008 and p<.001, respectively). S-ReSC score (p=.02) and stone burden (p<.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618). CONCLUSIONS: The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.
Subject(s)
Kidney Calculi , Humans , Kidney Calculi/surgery , Logistic Models , Postoperative Complications/epidemiology , Retrospective Studies , Seoul , Treatment Outcome , UniversitiesABSTRACT
Purpose: Retrograde intrarenal surgery (RIRS) is a safe and effective treatment option for upper urinary tract stones smaller than 2 cm. Although several studies have documented perioperative and postoperative complications related to RIRS, there exists limited data regarding the readmission and rehospitalization of patients after RIRS. The aims of the study were to document the rates of readmission and rehospitalization after RIRS and to determine the predictive factors for readmission and rehospitalization. Materials and Methods: In this study, we retrospectively analyzed patients who underwent RIRS for the treatment of renal stone disease and were unexpectedly readmitted to the hospital within 30 days after discharge. The hospital admission systems were used to determine readmissions and rehospitalizations. Readmission and rehospitalization rates, causes, and treatment procedures were evaluated. Univariate and multivariate analyses of clinicodemographic properties were performed to evaluate possible predictive factors for readmission and rehospitalization after RIRS. Results: A total of 1036 patients were included in the study. Of these patients, 103 (9.9%) were readmitted to the hospital. Among these readmissions, 35 patients (33.9%) were rehospitalized and 14 (13.6%) underwent surgical intervention. The most common reasons for readmission were renal colic and fever. The presence of preoperative pyuria (odds ratio [OR] 1.86), stone volume (OR 1.54), postoperative complications (OR 3.66), and stone-free status (OR 0.46) were predictive factors for readmission, whereas hospitalization time (OR 1.32), postoperative complications (OR 9.70), and stone-free status (OR 0.06) were predictive factors for rehospitalization after RIRS. Conclusion: Nearly 10% of patients who underwent RIRS were readmitted to the hospital within the first month after discharge, and some were rehospitalized. Preoperative pyuria, high stone volume, presence of postoperative complications, and low stone-free status predicted this readmission and rehospitalization. Clinicians must recognize these predictive factors and inform their patients about this possibility.
