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The fate of clinically insignificant residual fragments following retrograde intrarenal surgery and factors affecting spontaneous passage

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Abstract

The remaining stone fragments after retrograde intrarenal surgery (RIRS) can lead to stone recurrence/regrowth, or stone-related events (SRE). We aimed to delineate the clinical circumstances that are decisive for spontaneous passage of clinical insignificant residual fragments (CIRF) (primary outcome) and define risk factors for stone recurrence/regrowth and their clinical manifestation (secondary outcome). A total of 115 patients who had CIRF following RIRS were included in this study. Demographic, clinical data, stone, and anatomic characteristics including infundibulopelvic angle (IPA), infundibular length (IL) and follow-up data of patients were analyzed. The mean follow-up time was 27.5 ± 6.9 months. 31 (26.9%) patients passed the CIRF spontaneously. Patients were divided into two groups as spontaneous fragment passage group and fragment remaining group and compared with respect to demographic, clinical, stone-related, and anatomic characteristics. 61.2% of patients had lower pole CIRF in fragment remaining group and 83.3% of patients in spontaneous fragment passage group (p = 0.031). In addition, IPA was wider in spontaneous fragment passage group (60.7° vs 51.4°, p = 0.001). A subanalysis was performed for fragment remaining group. In 84 patients, 44 (52.4%) patients were stable for their CIRF at their follow-up and included in stable group. 40 (47.6%) patients experienced stone re-growth (27 patients) or SRE (13 patients) at their follow up. Patients in re-growth/SRE group were older (49.1 vs 39.4 years, p = 0.047), had higher body mass index (28.2 vs 27 kg/m2, p = 0.03) and larger CIRF (2.8 vs 2.1 mm). CIRFs may be not expelled spontaneously and they may lead to additional morbidity and lithotripsy interventions.

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Data availability

The data sets generated and/or analyzed during the current study are available in Figshare Repository at https://figshare.com/s/f41379a8fb354a8dfed4.

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The author(s) received no financial support for the research, authorship.

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Authors and Affiliations

  1. Department of Urology, Ankara City Hospital, Üniversiteler Mahallesi, 1604. Cadde No: 9 Çankaya, Ankara, Turkey

    Samet Senel, Kazim Ceviz, Cuneyt Ozden, Huseyin Gultekin & Cevdet Serkan Gokkaya

  2. First Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Antonios Koudonas

Authors
  1. Samet Senel
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  2. Kazim Ceviz
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  3. Cuneyt Ozden
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  4. Huseyin Gultekin
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  5. Cevdet Serkan Gokkaya
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  6. Antonios Koudonas
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Contributions

Conception and design: SS, CO; data acquisition: KC, HG; data analysis and interpretation: SS, CSG; drafting the manuscript: SS, AK; critical revision of the manuscript for scientific and factual content: CO; statistical analysis: SS; supervision: CO, CSG.

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Correspondence to Samet Senel.

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The present study protocol was reviewed and approved by the Institutional Review Board of Ankara City Hospital (approval number: E2-23-5914).

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Senel, S., Ceviz, K., Ozden, C. et al. The fate of clinically insignificant residual fragments following retrograde intrarenal surgery and factors affecting spontaneous passage. Urolithiasis 52, 39 (2024). https://doi.org/10.1007/s00240-024-01544-9

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