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Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study)

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Abstract

Aims

To outline and evaluate the incidence, management and follow-up of the residual fragments (RFs) following retrograde intrarenal surgery (RIRS) of renal stones by the Turkish Academy of Urology Prospective Study Group (ACUP Study).

Methods

Following the ethical committee approval, 15 centers providing data regarding the incidence, management, and follow-up of RFs after RIRS were included and all relevant information was recorded into the same electronic database program (https://acup.uroturk.org.tr/) created by Turkish Urology Academy for Residual Stone Study.

Results

A total of 1112 cases underwent RIRS for renal calculi and RFs were observed in 276 cases (24.8%). Of all the parameters evaluated, our results demonstrated no statistically significant relation between preoperative DJ stenting and the presence of RFs (χ2 (1) = 158.418; p = 0.099). RFs were significantly higher in patients treated with UAS (82 patients, 29.3%) during the procedure compared to the cases who did not receive UAS (194 patients, 23.3%) (χ2 (1) = 3.999; p = 0.046). The mean period for a secondary intervention after RIRS was 28.39 (± 12.52) days. Regarding the procedures applied for RF removal, re-RIRS was the most commonly performed approach (56%).

Conclusions

Despite the reported safe and successful outcomes, the incidence of RFs is higher, after the RIRS procedure particularly in cases with relatively larger calculi. Such cases need to be followed in a close manner and although a second flexible ureteroscopy is the treatment of choice for fragment removal in the majority of these patients, shock wave lithotripsy and percutaneous nephrolithotomy may also be preferred in selected cases.

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References

  1. Park HK, Kim JH, Min GE, Choi WS, Li S, Chung KJ, Chung BI. Change of trends in the treatment modality for pediatric nephrolithiasis: retrospective analysis of a US-based insurance claims database. J Endourol. 2019. https://doi.org/10.1089/end.2019.0154 (Epub ahead of print; PubMed PMID: 31016995)

  2. Secker A, Rassweiler J, Neisius A (2019) Future perspectives of flexible ureteroscopy. Curr Opin Urol 29(2):113–117. https://doi.org/10.1097/MOU.0000000000000575(PubMed PMID: 30668555)

    Article  PubMed  Google Scholar 

  3. Beck EM, Riehle RA (1991) The fate of residual fragments after SWL monotherapy of infection stones. J Urol 145:6–10

    Article  CAS  Google Scholar 

  4. Atis G, Pelit ES, Culpan M et al (2018) The fate of residual fragments after retrograde intrarenal surgery in long-term follow-up. Urol J. https://doi.org/10.22037/uj.v0i0.4124(PubMed PMID: 30033513)

    Article  Google Scholar 

  5. Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N, Miernik A (2012) Postureteroscopic lesion scale: a new management modified organ injury scale–evaluation in 435 ureteroscopic patients. J Endourol 26(11):1425–1430. https://doi.org/10.1089/end.2012.0227

  6. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187

    Article  Google Scholar 

  7. Akand M, Sarıca K, Kiremit MC, Soytaş M, Güven S (2019) Development of a prospective data registry system for retrograde intrarenal surgery in renal stones: Turkish Academy of Urology Prospective Study Group (ACUP study). Turk J Urol. https://doi.org/10.5152/tud.2019.19143 (Epub ahead of print; PubMed PMID: 31747366)

  8. Skolarikos A (2012) Management of residual stone fragments. In: Smith AD, Badlani GH, Preminger GM, Kavoussi LR (eds) Smith’s Endourology, 3rd edn. Blackwell Publishing Ltd, Oxford, pp 662–674

    Chapter  Google Scholar 

  9. Kiremit MC, Guven S, Sarica K, Ozturk A, Buldu I, Kafkasli A, Balasar M, Istanbulluoglu O, Horuz R, Cetinel CA, Kandemir A, Albayrak S (2015) Contemporary management of medium-sized (10–20 mm) renal stones: a retrospective multicenter observational study. J Endourol 29(7):838–843. https://doi.org/10.1089/end.2014.0698(Epub 2015 Mar 6; PubMed PMID: 25578510)

    Article  PubMed  Google Scholar 

  10. Suarez-Ibarrola R, Hein S, Miernik A (2019) Residual stone fragments: clinical implications and technological innovations. Curr Opin Urol 29(2):129–134. https://doi.org/10.1097/MOU.0000000000000571(PubMed PMID: 30407220)

    Article  PubMed  Google Scholar 

  11. Pearle MS, Watamull LM, Mullican MA (1999) Sensitivity of noncontrast helical computerized tomography and plain film radiography compared to flexible nephroscopy for detecting residual fragments after percutaneous nephrostolithotomy. J Urol 162:23

    Article  CAS  Google Scholar 

  12. Fabrizio MD, Behari A, Bagley DH (1998) Ureteroscopic management of intrarenal calculi. J Urol 159:1139

    Article  CAS  Google Scholar 

  13. Sofer M, Watterson JD, Wollin TA et al (2002) Holmium: YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol 167:31

    Article  Google Scholar 

  14. Erhard M, Salwen J, Bagley DH (1996) Uretero- scopic removal of mid and proximal ureteral calculi. J Urol 155:38

    Article  CAS  Google Scholar 

  15. Jiang H, Wu Z, Ding Q et al (2007) Ureteroscopic treatment of ureteral calculi with holmium: YAG laser lithotripsy. J Endourol 21:151

    Article  Google Scholar 

  16. Parker BD, Frederick RW, Reilly TP et al (2004) Efficiency and cost of treating proximal ureteral stones: shock wave lithotripsy versus ureteroscopy plus holmium:yttrium-aluminum-garnet laser. Urology 64:1102

    Article  Google Scholar 

  17. Rippel CA, Nikkel L, Lin YK, Danawala Z, Olorunnisomo V, Youssef RF, Pearle MS, Lotan Y, Raman JD (2012) Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol. 188(6):2246–2251

    Article  Google Scholar 

  18. Macejko A, Okotie OT, Zhao LC et al (2009) Computed tomography-determined stone-free rates for ure- teroscopy of upper-tract stones. J Endourol 23:379

    Article  Google Scholar 

  19. Ozgor F, Simsek A, Binbay M, Akman T, Kucuktopcu O, Sarilar O, Muslumanoglu AY, Berberoglu Y (2014) Clinically insignificant residual fragments after flexible ureterorenoscopy: medium-term follow-up results. Urolithiasis 42(6):533–538. https://doi.org/10.1007/s00240-014-0691-y(Epub 2014 Aug 1; PubMed PMID:25081327)

    Article  PubMed  Google Scholar 

  20. de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, Preminger G, Traxer O, CROES URS Study Group (2014) The clinical research office of the endourological society ureteroscopy global study: indications, complications, andoutcomes in 11,885 patients. J Endourol 28(2):131–139. https://doi.org/10.1089/end.2013.0436 (Epub 2013 Dec 17; PubMed PMID: 24147820)

  21. Portis AJ, Rygwall R, Holtz C et al (2006) Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup. J Urol 175:2129

    Article  Google Scholar 

  22. Perlmutter AE, Talug C, Tarry WF et al (2008) Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology 71:214

    Article  Google Scholar 

  23. Resorlu B, Oguz U, Resorlu EB et al (2012) The impact of pelvicaliceal anatomy on the success of retro- grade intrarenal surgery in patients with lower pole renal stones. Urology 79:6

    Article  Google Scholar 

  24. Patel N, Chew B, Knudsen B, Lipkin M, Wenzler D, Sur RL (2014) Accuracy of endoscopic intraoperative assessment of urologic stone size. J Endourol 28(5):582–586. https://doi.org/10.1089/end.2013.0707(Epub 2014 Jan 22; PubMed PMID:24341294)

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge the financial support from the Turkish Association of Urology and thank Prof Dr. Ates Kadioglu, the coordinator of the Turkish Academy of Urology, for his valuable support during the study period.

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Authors and Affiliations

  1. Department of Urology, Istanbul Medipol University, TEM Otoyolu No. 1, Bagcilar, 34214, Istanbul, Turkey

    Selcuk Guven, Mustafa Yucel Boz & Bulent Erkurt

  2. Department of Medical Statistics and Medical Informatics, Istanbul Medipol University, Istanbul, Turkey

    Pakize Yigit

  3. Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey

    Altug Tuncel & Çagdas Senel

  4. Department of Urology, Erzurum Research and Training Hospital, University of Health Sciences, Erzurum, Turkey

    İbrahim Karabulut

  5. Department of Urology, Bakirköy Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey

    Selcuk Sahin, Mustafa Soytas & Volkan Tugcu

  6. Department of Urology, Selcuklu Medical School, Selcuk University, Konya, Turkey

    Ozcan Kilic & Murat Akand

  7. Department of Urology, Meram Medical School, Necmettin Erbakan University, Konya, Turkey

    Mehmet Balasar & Mehmet Giray Sonmez

  8. Department of Urology, Gaziantep University, Gaziantep, Turkey

    Ilker Seckiner

  9. Department of Urology, Yıldırım Beyazit University, Ankara, Turkey

    Erdem Canda

  10. Department of Urology, Istanbul Medical School, Istanbul University, Istanbul, Turkey

    Tzevat Tefik

  11. Department of Urology, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey

    Gokhan Atis

  12. Department of Urology, Koru Hospital, Ankara, Turkey

    Giray Ergin & Mustafa Kirac

  13. Department of Urology, Koc University, Istanbul, Turkey

    Murat Can Kiremit

  14. Department of Urology, Bagcilar Research and Training Hospital, University of Health Sciences, Istanbul, Turkey

    Ahmet Muslumanoglu

  15. Department of Urology, Biruni University, Istanbul, Turkey

    Kemal Sarica

Authors
  1. Selcuk Guven
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  2. Pakize Yigit
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  3. Altug Tuncel
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  4. İbrahim Karabulut
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  5. Selcuk Sahin
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  8. Ilker Seckiner
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  9. Erdem Canda
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  11. Tzevat Tefik
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  12. Mustafa Yucel Boz
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  13. Gokhan Atis
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  14. Giray Ergin
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  15. Mustafa Soytas
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  16. Çagdas Senel
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  17. Mustafa Kirac
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  18. Murat Can Kiremit
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  19. Murat Akand
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  20. Volkan Tugcu
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  21. Bulent Erkurt
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  22. Ahmet Muslumanoglu
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  23. Kemal Sarica
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Contributions

SG: Project development, Data collection, Data management, Data analysis, Manuscript writing. PY: Project development, Data management, Data analysis. AT: Project development, Data management, Data collection. İK: Project development, Data collection. SS: Project development, Data collection. OK: Project development, Data collection. MB: Project development, Data collection. IS: Data collection. EC: Data collection. MGS: Data collection. TT: Project development, Data collection. MYB: Data collection. GA: Data collection. GE: Data collection. MS: Project development, Data collection. ÇS: Data collection. MK: Data collection. MCK: Project development, Data management, Data analysis. MA: Data collection, Manuscript editing. VT: Data collection. BE: Data collection. AYM: Data collection. KS: Data collection, Data management, Data analysis, Manuscript writing.

Corresponding author

Correspondence to Selcuk Guven.

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The authors declare that they have no conflict of interest.

Research involving human participants

The study was approved by the ethical committee of Istanbul Medipol University. The study was performed in accordance with the ethical standards of 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants and from their parents included in the study.

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Guven, S., Yigit, P., Tuncel, A. et al. Retrograde intrarenal surgery of renal stones: a critical multi-aspect evaluation of the outcomes by the Turkish Academy of Urology Prospective Study Group (ACUP Study). World J Urol 39, 549–554 (2021). https://doi.org/10.1007/s00345-020-03210-2

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  • DOI: https://doi.org/10.1007/s00345-020-03210-2

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