Improving Outcomes of Same-sitting Bilateral Flexible Ureteroscopy for Renal Stones in Real-world Practice-Lessons Learnt from Global Multicenter Experience of 1250 Patients
Por:
Castellani, D, Traxer, O, Ragoori, D, Galosi, AB, De Stefano, V, Gadzhiev, N, Tanidir, Y, Inoue, T, Emiliani, E, Bin Hamri, S, Lakmichi, MA, Vaddi, CM, Heng, CT, Soebhali, B, More, S, Sridharan, V, Gokce, MI, Tursunkulov, AN, Ganpule, A, Pirola, GM, Naselli, A, Aydin, C, Chillon, FRD, Mendoza, CS, Candela, L, Chew, B, Somani, BK, Gauhar, V
Publicada:
1 jun 2023
Ahead of Print:
30 abr 2023
Resumen:
Background: Bilateral kidney stones are commonly treated in staged procedures. Objective: To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones. Design, setting, and participants: Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/ stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo. Outcome measurements and statistical analysis: Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR. Results and limitations: A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The med-ian surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, p = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, p < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, p < 0.001), surgical time >100 min (OR 2.86, 95% CI 1.12- 7.31, p = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35- 2.62, p < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, p = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, p < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, p < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis. Conclusions: SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones. Patient summary: In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.& COPY; 2023 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creative-commons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Castellani, D:
Univ Politecn Marche, Urol Unit, Azienda Osped Univ Marche, Via Conca 71, I-60126 Ancona, Italy
Traxer, O:
Sorbonne Univ, Tenon Hosp, AP HP, Dept Urol, Paris, France
Ragoori, D:
Asian Inst Nephrol & Urol, Dept Urol, Hyderabad, Telangana, India
Galosi, AB:
Univ Politecn Marche, Urol Unit, Azienda Osped Univ Marche, Via Conca 71, I-60126 Ancona, Italy
De Stefano, V:
Univ Politecn Marche, Urol Unit, Azienda Osped Univ Marche, Via Conca 71, I-60126 Ancona, Italy
Gadzhiev, N:
St Petersburg State Univ Hosp, Dept Urol, St Petersburg, Russia
Tanidir, Y:
Marmara Univ, Sch Med, Dept Urol, Istanbul, Turkiye
Inoue, T:
Kobe Univ, Hara Genitourinary Private Hosp, Dept Urol, Kobe, Japan
Emiliani, E:
Autonomos Univ Barcelona, Fdn Puigvert, Dept Urol, Barcelona, Spain
Bin Hamri, S:
King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Dept Surg, Div Urol,Minist Natl Guard Hlth Affairs, Riyadh, Saudi Arabia
Lakmichi, MA:
Univ Hosp Mohammed VIth Marrakesh, Dept Urol, Marrakech, Morocco
Vaddi, CM:
Preeti Urol & Kidney Hosp, Dept Urol, Hyderabad, India
Heng, CT:
Ng Teng Fong Gen Hosp, Dept Urol, Singapore, Singapore
Soebhali, B:
Mulawarman Univ, Abdul Wahab Sjahranie Hosp, Dept Urol, Med Fac, Samarinda, Indonesia
More, S:
Sarvodaya Hosp & Res Ctr, Dept Urol, Faridabad, India
Sridharan, V:
Sree Paduka Special Hosp, Dept Urol, Thillai Nagar, India
Gokce, MI:
Ankara Univ, Sch Med, Dept Urol, Ankara, Turkiye
Tursunkulov, AN:
AkfaMedline Hosp, Urol Div, Tashkent, Uzbekistan
Ganpule, A:
Muljibhai Patel Urol Hosp, Dept Urol, Nadiad, Gujarat, India
Pirola, GM:
San Giuseppe Hosp, Urol Dept, IRCCS Multimed, Multimed Grp, Milan, Italy
Naselli, A:
San Giuseppe Hosp, Urol Dept, IRCCS Multimed, Multimed Grp, Milan, Italy
Aydin, C:
Hitit Univ, Sch Med, Dept Urol, Corum, Turkiye
Chillon, FRD:
Clin Univ Navarra, Dept Urol, Madrid, Spain
Mendoza, CS:
Sorbonne Univ, Tenon Hosp, AP HP, Dept Urol, Paris, France
Uroclin SAS, Dept Endourol, Medellin, Colombia
Candela, L:
Sorbonne Univ, Tenon Hosp, AP HP, Dept Urol, Paris, France
Univ Vita Salute San Raffaele, Urol Res Inst, Div Expt Oncol, Unit Urol,IRCCS Osped San Raffaele, Milan, Italy
Chew, B:
Univ British Columbia, Dept Urol, Vancouver, BC, Canada
Somani, BK:
Univ Hosp Southampton NHS Trust, Dept Urol, Southampton, England
Gauhar, V:
Ng Teng Fong Gen Hosp, Dept Urol, Singapore, Singapore
gold, Green Published, All Open Access, Gold, Green
|