Gone are the days of RIRS being solely used for sub-centimeter renal stones as RIRS is slowly establishing itself as an alternative to PCNL for larger stones. Al Kadhi and colleagues evaluated the use of flexible ureteroscopy as first line therapy for stones >1cm. (MP19-06) In their report, the overall success rate was 57.6% for stones of mean maximum diameter of 23.3 mm. Success rates were dependent on stone size (68.2% vs. 36.4% for stones <25mm vs. >25mm, p=0.009) and location (renal pelvis, upper pole, interpolar, lower pole success rates of 80% 58.3%, 66.7% and 34.6% respectively).
The report by Roberto Peschechera and associates confirmed the findings that RIRS has a size limitation that ultimately affects success rate. They found that for stones <3cm vs, >3cm, RIRS had longer OR times (98.4min vs. 138.4, p=0.021), more septic complications (4.2% vs. 12.5%, p<0.001), and lower stone free rates after 1, 2 and 3 procedures. These studies demonstrate that in the appropriately selected patient, RIRS is a viable alternative although larger prospective studies are necessary to confirm these findings.
Also:
Three cm is the cut off to maximize the outcomes of RIRS for renal calculi larger than 2 cm
by Roberto Peschechera
Presented by Omar S. Al Kadhi at the 29th World Congress of Endourology & SWL (WCE) - November 30 - December 3, 2011 - Kyoto International Conference Center - Kyoto, Japan
Reported for UroToday by Joseph Graversen, Fellow Minimally Invasive Surgery and Endourology, University of California-Irvine Medical Center, Irvine, CA
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