Indications, preferences, global practice patterns and outcomes in retrograde intrarenal surgery (RIRS) for renal stones in adults: results from a multicenter database of 6669 patients of the global FLEXible ureteroscopy Outcomes Registry (FLEXOR)

Gauhar V 1 , Chew BH 2 , Traxer O 3 , Tailly T 4 , Emiliani E 5 , Inoue T 6 Show all authors , Tiong HC 1 , Chai CA 7 , Lakmichi MA 8 , Tanidir Y 9 , Bin Hamri S 10 , Desai D 11 , Biligere S 1 , Shrestha A 12 , Soebhali B 13 , Keat WOL 14 , Mohan VC 15 , Bhatia TP 16 , Singh A 17 , Saleem M 18 , Gorelov D 19 , Gadzhiev N 19 , Pietropaolo A 20 , Galosi AB 21 , Ragoori D 22 , Teoh JY 23 , Somani BK 20 , Castellani D 24

Affiliations 

  • 1 Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
  • 2 Department of Urology, University of British Columbia, Vancouver, Canada
  • 3 Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
  • 4 Department of Urology, University Hospital of Ghent, Ghent, Belgium
  • 5 Urology Department, Universidad Autónoma de Barcelona, Fundación PuigvertBarcelona, Spain
  • 6 Department of Urology and Stone Center, Hara Genitourinary Hospital, Kobe City, Hyogo, Japan
  • 7 Urology Unit, Department of Surgery, University Malaya, Kuala Lumpur, Malaysia
  • 8 Department of Urology, University Hospital Mohammed the VIth of Marrakesh, Marrakesh, Morocco
  • 9 Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
  • 10 Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • 11 Department of Urology, Toowoomba Hospital, University of Queensland, Brisbane, Australia
  • 12 Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • 13 Medical Faculty, Mulawarman University, Abdul Wahab Sjahranie Hospital, Samarinda, Indonesia
  • 14 Department of Urology, Penang General Hospital, Penang, Malaysia
  • 15 Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, Telangana, India
  • 16 Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India
  • 17 Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
  • 18 Department of Urology, Apis Kidney Stone Institute, Urology Research and Day Care Center, Mangalore, Karnataka, India
  • 19 Endourology Department, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
  • 20 Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
  • 21 Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
  • 22 Department of Urology, Asian Institute of Nephrology & Urology, Irram Manzil Colony, Hyderabad, Telangana, India
  • 23 S. H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
  • 24 Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy. castellanidaniele@gmail.com
World J Urol, 2023 Feb;41(2):567-574.
PMID: 36536170 DOI: 10.1007/s00345-022-04257-z

Abstract

PURPOSE: To collect a multicentric database on behalf of TOWER research group to assess practice patterns and outcomes of retrograde intrarenal surgery (RIRS) for kidney stones.

METHODS: Inclusion criteria: age ≥ 18 years, normal renal/calyceal system anatomy, calculi of any size, number, and position.

STUDY PERIOD: January 2018 and August 2021. Stone-free status: absence of fragments > 2 mm, assessed post procedure according to the local protocol (KUB X-Ray and/or ultrasound or non-contrast CT scan).

RESULTS: Twenty centers from fifteen countries enrolled 6669 patients. There were 4407 (66.2%) men. Mean age was 49.3 ± 15.59 years. Pain was the most frequent symptom indication for intervention (62.6%). 679 (10.2%) patients underwent RIRS for an incidental finding of stones. 2732 (41.0%) patients had multiple stones. Mean stone size was 10.04 ± 6.84 mm. A reusable flexible ureteroscope was used in 4803 (72.0%) procedures. A sheath-less RIRS was performed in 454 (6.8%) cases. Holmium:YAG laser was used in 4878 (73.1%) cases. A combination of dusting and fragmentation was the most common lithotripsy mode performed (64.3%). Mean operation time was 62.40 ± 17.76 min. 119 (1.8%) patients had an intraoperative injury of the ureter due to UAS insertion. Mean postoperative stay was 3.62 ± 3.47 days. At least one postoperative complication occurred in 535 (8.0%) patients. Sepsis requiring intensive care admission occurred in 84 (1.3%) patients. Residual fragments were detected in 1445 (21.7%) patients. Among the latter, 744 (51.5%) patients required a further intervention.

CONCLUSION: Our database contributes real-world data to support to a better understanding of modern RIRS practice and outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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