Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

Chai CA 1 , Teoh YC 2 , Tailly T 3 , Emiliani E 4 , Inoue T 5 , Tanidir Y 6 Show all authors , Gadzhiev N 7 , Bin Hamri S 8 , Ong WL 9 , Shrestha A 10 , Ragoori D 11 , Lakmichi MA 12 , Gorelov D 13 , Soebhali B 14 , Vaddi CM 15 , Bhatia TP 16 , Desai D 17 , Durai P 18 , Heng CT 18 , Chew B 19 , Castellani D 20 , Somani B 21 , Traxer O 22 , Gauhar V 18 , TOWER Group

Affiliations 

  • 1 Unit of Urology, Department of Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia - vineetgaauhaar@gmail.com
  • 2 S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
  • 3 Department of Urology, University Hospital of Ghent, Ghent, Belgium
  • 4 Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
  • 5 Hara Genitourinary Private Hospital, University of Kobe, Kobe, Japan
  • 6 Department of Urology, School of Medicine, Marmara University, Istanbul, Türkiye
  • 7 Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
  • 8 Division of Urology, Department of Surgery, Ministry of the National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
  • 9 Department of Urology, Penang General Hospital, Penang, Malaysia
  • 10 National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
  • 11 Asian Institute of Nephrology and Urology, Hyderabad, India
  • 12 Department of Urology, University Hospital Mohammed VI of Marrakesh, Cadi Ayyad University, Marrakesh, Morocco
  • 13 Department of Endourology, Saint-Petersburg State Medical University, Saint-Petersburg, Russia
  • 14 Faculty of Medicine, Abdul Wahab Sjahranie Hospital, Mulawarman University, Mulawarman, Indonesia
  • 15 Department of Urology, Preeti Urology and Kidney Hospital, Hyderabad, India
  • 16 Department of Urology, Sarvodaya Healthcare, Faridabad, Haryana, India
  • 17 Department of Urology, Toowoomba Base Hospital, Toowoomba, Australia
  • 18 Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
  • 19 Department of Urology, University of British Columbia, Vancouver, BC, Canada
  • 20 AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
  • 21 Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  • 22 Department of Urology, GRC Urolithiasis, Tenon Hospital, Sorbonne University, Paris, France
Minerva Urol Nephrol, 2023 Aug;75(4):493-500.
PMID: 37293816 DOI: 10.23736/S2724-6051.23.05239-4

Abstract

BACKGROUND: Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes.

METHODS: A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded.

RESULTS: Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001).

CONCLUSIONS: RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

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

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