RESUMO
OBJECTIVES: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificant residual fragments (CIRF) could not pass from the kidney. We aimed to find out the differences on the fate of CIRF according to being in the lower pole or other renal localizations. METHODS: 81 patients whose stones were fragmented completely by RIRS were subdivided into two groups as group 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients). Basal characteristics, urine culture, and renal stone screening were evaluated before and 1-year later from the surgery. RESULTS: While the number of stone-free patients was less and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, there was no statistical difference between the two groups (p=0.158, p=0.136). The number of patients whose CIRFs regrew was 46.3% in group 1 and, 52.5% in group 2. A positive correlation was detected between preoperative stone size and first-year maximal residual fragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of the postoperative first-year residual fragment size in group 1. CONCLUSIONS: We observed that almost the half of the CIRFs in all renal localizations regrew and became symptomatic. There is an effect of the stone size on the residual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF are needed to be followed-up more closely regardless of the renal localization in order to assess the requirement of retreatment.
OBJETIVOS: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentos residuales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer las diferencias en el destino del FRCI según esten en el polo inferior u otras localizaciones renales.MATERIAL Y MÉTODOS: 81 pacientes cuyos cálculos se fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41 pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales, urocultivo y cribado de cálculos renales se evaluaron antes y un año después de la cirugía. RESULTADOS: Mientras que el número de pacientes sin cálculos fue menor y los pacientes con FRCI ≤4 mm fue mayor en el grupo de cálculos del polo inferior 1 año después de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número de pacientes cuyo FRCI volvió a crecer fue del 46,3% en el grupo 1 y del 52,5% en el grupo 2. Se detectó una correlación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual del primer año en el grupo 1. El análisis de regresión lineal sugirió que el tamaño del cálculo preoperatorio es un predictor del tamaño del fragmento residual del primer año posoperatorio en el grupo 1. CONCLUSIÓNES: Observamos que casi la mitad de los FRCI en todas las localizaciones renales volvieron a aparecer y se volvieron sintomáticos. Hay un efecto del tamaño del cálculo sobre el tamaño del fragmento residual mientras se realiza la CRIR, en particular, para los cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes con FRCI independientemente de la localización renal para evaluar la necesidad de retratamiento.
Assuntos
Cálculos Renais , Seguimentos , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Cálculos Renais/cirurgia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Objetivos: Incluso después de una cirugía intrarrenal retrógrada exitosa (CRIR), fragmentosresiduales clínicamente insignificantes (FRCI) no pudieron pasar del riñón. Nuestro objetivo fue conocer lasdiferencias en el destino del FRCI según esten en el poloinferior u otras localizaciones renales.Material y métodos: 81 pacientes cuyos cálculosse fragmentaron completamente por CRIR se subdividieron en dos grupos: grupo 1 (polo inferior con 41pacientes) y grupo 2 (polo superior, polo medio y pelvis renal con 40 pacientes). Las características basales,urocultivo y cribado de cálculos renales se evaluaronantes y un año después de la cirugía.Resultados: Mientras que el número de pacientes sincálculos fue menor y los pacientes con FRCI ≤4 mm fuemayor en el grupo de cálculos del polo inferior 1 añodespués de la cirugía, no hubo diferencia estadística entre los dos grupos (p=0,158, p=0,136). El número depacientes cuyo FRCI volvió a crecer fue del 46,3% enel grupo 1 y del 52,5% en el grupo 2. Se detectó unacorrelación positiva entre el tamaño del cálculo preoperatorio y el tamaño máximo del fragmento residual delprimer año en el grupo 1. El análisis de regresión linealsugirió que el tamaño del cálculo preoperatorio es unpredictor del tamaño del fragmento residual del primeraño posoperatorio en el grupo 1.Conclusiones: Observamos que casi la mitad delos FRCI en todas las localizaciones renales volvierona aparecer y se volvieron sintomáticos. Hay un efectodel tamaño del cálculo sobre el tamaño del fragmentoresidual mientras se realiza la CRIR, en particular, paralos cálculos renales del polo inferior. Es necesario realizar un seguimiento más detenido de los pacientes conFRCI independientemente de la localización renal paraevaluar la necesidad de retratamiento.(AU)
Objetives: Even after a successful retrograde intrarenal surgery (RIRS), clinically insignificantresidual fragments (CIRF) could not pass from the kidney.We aimed to find out the differences on the fate of CIRFaccording to being in the lower pole or other renal localizations.Methods: 81 patients whose stones were fragmentedcompletely by RIRS were subdivided into two groups asgroup 1 (lower pole with 41 patients) and group 2 (upper pole, midpole, and renal pelvis with 40 patients).Basal characteristics, urine culture, and renal stonescreening were evaluated before and 1-year later fromthe surgery.Results: While the number of stone-free patients wasless and patients with CIRF ≤4 mm was higher in the lower pole stone group 1-year later from the surgery, therewas no statistical difference between the two groups(p=0.158, p=0.136). The number of patients whoseCIRFs regrew was 46.3% in group 1 and, 52.5% ingroup 2. A positive correlation was detected betweenpreoperative stone size and first-year maximal residualfragment size in group 1. Linear regression analysis suggested that preoperative stone size is a predictor of thepostoperative first-year residual fragment size in group 1.Conclsions: We observed that almost the half ofthe CIRFs in all renal localizations regrew and becamesymptomatic. There is an effect of the stone size on theresidual fragment size while performing RIRS for particularly the lower pole renal stones. Patients with CIRF areneeded to be followed-up more closely regardless of therenal localization in order to assess the requirement ofretreatment.(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Nefropatias , Nefrolitíase , Estudos Prospectivos , Urologia , Doenças UrológicasRESUMO
AIMS: To compare the efficacy of different laser devices and power ranges on lithotripsy in retrograde intrarenal surgery (RIRS) for 1-2 cm kidney stones. METHODS: A total of 223 participants undergoing RIRS for 1-2 cm kidney stones at our clinic between January 2015 and January 2017 were recruited for this prospective study (NCT02451319). Two hundred and four participants included in our study were randomly allocated into either ≤20 W with 20 W laser device (group 1) or ≤20 W with 30 W laser device (group 2) or >20 W with 30 W laser device (group 3). RESULTS: There was no significant difference between the groups in terms of demographic and stone characteristics. Operation and fluoroscopy times were significantly longer (P = .003 and P < .001, respectively) and stone-free rate (SFR) was significantly lower in group 1 (P = .002). Complications were similar in all three groups (P = .512). However, post-operative pain scores were significantly higher in group 1 (P < .001). The multivariate analysis revealed that stone size (95% CI: 0.654-0.878, OR = 0.758, P < .001), ureteral access sheath use (95% CI: 1.003-20.725, OR = 4.560, P = .049), and lithotripsy with 30 W laser device (95% CI: 1.304-11.632, OR = 3.895, P = .015; 95% CI: 1.738-17.281, OR = 5.480, P = .004, groups 2 and 3, respectively) were independent factors predicting SFR for RIRS used in 1-2 cm kidney stones. CONCLUSION: The 30 W laser device used in RIRS for 1-2 cm kidney stones had shorter operation times, higher SFRs, and lower post-operative pain scores compared with the 20 W device. The 30 W laser device is safe and more efficient in RIRS for treatment of 1-2 cm kidney stones.
Assuntos
Cálculos Renais , Litotripsia , Humanos , Cálculos Renais/cirurgia , Lasers , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: Holmium:Yttrium Aluminum Garnet laser lithotripsy is used in Retrograde Intrarenal Surgery. Fragmentation is made with a certain value of pulse energy (Joule) and frequency (Hertz) in Holmium laser lithotripsy and the multiplication of these values gives us total power (Watt). Devices with maximum power of 20 Watt and 30 Watt are used in clinical practice. We want to compare the efficiency, safety and pain scores of the lithotripsy made below 20 Watt and over 30 Watt with 30 Watt laser device. MATERIALS AND METHODS: 60 patients who had 2-3 cm sized kidney stones and operation planned were prospectively divided into three groups. Groups were random identified. In the first group, fragmentation was performed below 20 Watt power with 20 Watt laser device. In the second group, fragmentation was performed below 20 Watt power with 30 Watt laser device. In the third group, fragmentation was performed over 20 Watt power with 30 Watt laser device. Demographic, stone, intraoperative and postoperative data were recorded. We compared these groups regarding efficiency, safety and pain score. RESULTS: For demographic and stone data, there was a statistically significant difference only for stone number. For intraoperative and postoperative data, there was a statistically significant difference only for ureteral access sheath usage between the groups. Success was lower than the other groups in Group 1. CONCLUSIONS: Success was higher in groups using 30 Watt laser device. There was not statistically significantly difference between complications and pain. 30 Watt laser device is safe and efficient in Retrograde Intrarenal Surgery.
Assuntos
Cálculos Renais/terapia , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Dor Processual/diagnóstico , Adulto , Idoso , Feminino , Tecnologia de Fibra Óptica , Humanos , Lasers de Estado Sólido/efeitos adversos , Litotripsia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Processual/etiologia , Estudos Prospectivos , Resultado do Tratamento , Ureteroscopia/métodosRESUMO
Purpose: Management of ? 4 cm sized kidney stone is a rarely seen problem in urology. Few studies are present about this issue. Percutaneous nephrolithotomy(PNL), Retrograde Intrarenal Surgery(RIRS) and open surgery are the methods used in stone management. In our study we aimed to compare RIRS and PNL in the management of ? 4 cm sized kidney stones. MATERIALS AND METHODS: Among patients who had undergone RIRS and PNL in D?skap? Y?ld?r?m Beyaz?t Train-ing and Research Hospital, 94 patients who had ? 4 cm sized kidney stones were included our study. The demo-graphic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively. RESULTS: 94 patients (67 PNL, 27 RIRS) were in the study. Stone laterality, urinary anomaly and gender were sim-ilar in two groups.(Group PNL(P) and Group RIRS(R)) Stone number were 2.55 ± 1.44 and 2.78 ± 1.42 in Group P and R, respectively. Stone size were 47.06 ± 7.02 and 46.41 ± 6.00 mm. in Group P and R, respectively. The differences between two groups were not statistically significant.(P > .05) In Group P scopy time, hospital stay and stone free rate were higher and operation time was lower than Group R. And the difference was statistically significant(P < .05). CONCLUSIONS: As a result, PNL is an effective method and operation time is lower than RIRS. Also a second oper-ation for JJ stent taking is lower in PNL . RIRS is a safe method. RIRS has less complications and hospitalization time. They are feasible in treatment of ? 4 cm sized kidney stones.
