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Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group

Gauhar V 1 , Castellani D 2 , Chew BH 3 , Smith D 4 , Chai CA 5 , Fong KY 6 Show all authors , Teoh JY 7 , Traxer O 8 , Somani BK 9 , Tailly T 10

Affiliations 

  • 1 Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
  • 2 Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy
  • 3 Department of Urology, University of British Columbia, Vancouver, BC, Canada
  • 4 Institute of Urology, University College Hospital London, London, UK
  • 5 Urology Unit, Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
  • 6 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 7 S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
  • 8 Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France
  • 9 Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
  • 10 Department of Urology, University Hospital of Ghent, Ghent, Belgium
Ther Adv Urol, 2023;15:17562872231198629.
PMID: 37701535 DOI: 10.1177/17562872231198629

Abstract

BACKGROUND: Assessment of residual fragments (RFs) is a key step after treatment of kidney stones.

OBJECTIVE: To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones.

DESIGN: A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021).

METHODS: Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs.

RESULTS: A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p 

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

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