Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?
BACKGROUND
Major kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.


METHODS
By retrospective analysis, we identified a total of 162 patients who were affected by stones greater than 2 cm in diameter and who had undergone RIRS. We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications.


RESULTS
The mean stone size was 2.7 cm +/- 0.6 cm. The primary, secondary, and tertiary stone-free rates were 66%, 80.9%, and 87.7%, respectively. The mean number of procedures per patient was 1.48. The complication rates according to the Clavien-Dindo classification were Clavien I in 20.4% of patients, Clavien II in 0%, Clavien III in 4.9%, Clavien IV in 0.6%, and Clavien V in 0%.


CONCLUSIONS
As an alternative to standard procedures for the treatment of renal calculi greater than 2 cm in diameter, RIRS is safe and effective, with a low complication rate.
IRCCS Humanitas Clinical and Research Center, Milan, Italy.
Guido
G
Giusti
Silvia
S
Proietti
Lorenzo G
LG
Luciani
Roberto
R
Peschechera
Antonella
A
Giannantoni
Gianluigi
G
Taverna
Giuseppe
G
Sortino
Pierpaolo
P
Graziotti
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods