Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Feb;41(2):567-574.
doi: 10.1007/s00345-022-04257-z. Epub 2022 Dec 19.

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)

Vineet Gauhar  1 , Ben Hall Chew  2 , Olivier Traxer  3 , Thomas Tailly  4 , Esteban Emiliani  5 , Takaaki Inoue  6 , Heng Chin Tiong  1 , Chu Ann Chai  7 , Mohamed Amine Lakmichi  8 , Yiloren Tanidir  9 , Saeed Bin Hamri  10 , Devang Desai  11 , Sarvajit Biligere  1 , Anil Shrestha  12 , Boyke Soebhali  13 , William Ong Lay Keat  14 , Vaddi Chandra Mohan  15 , Tanuj Paul Bhatia  16 , Abhishek Singh  17 , Mohamed Saleem  18 , Dmitry Gorelov  19 , Nariman Gadzhiev  19 , Amelia Pietropaolo  20 , Andrea Benedetto Galosi  21 , Deepak Ragoori  22 , Jeremy Yuen-Chun Teoh  23 , Bhaskar Kumar Somani  20 , Daniele Castellani  24
Affiliations
Multicenter Study

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)

Vineet Gauhar et al. World J Urol. 2023 Feb.

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.

Keywords: Flexible ureteroscopy; Kidney calculi; Laser; Lithotripsy; Retrograde intrarenal surgery.

PubMed Disclaimer

Comment in

References

    1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline, PART I. J Urol 196:1153–1160. https://doi.org/10.1016/j.juro.2016.05.090 - DOI - PubMed
    1. Skolarikos A, A. Neisius A, Petřík A, et al (2022) EAU Guidelines 2022 on Urolithiasis. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidel... . Accessed 17 Aug 2022
    1. Inoue T, Okada S, Hamamoto S, Fujisawa M (2021) Retrograde intrarenal surgery: Past, present, and future. Investig Clin Urol 62:121–135. https://doi.org/10.4111/icu.20200526 - DOI - PubMed - PMC
    1. Galosi AB, Dell’Atti L, Castellani D, et al (2022) Is spinal anesthesia a safe alternative for retrograde intrarenal surgery for stone disease in daily practice? Arch Esp Urol 75:361–367. https://doi.org/10.37554/en-j.arch.esp.urol-20210525-3501-21
    1. Bosio A, Dalmasso E, Alessandria E, et al (2018) Retrograde intra-renal surgery under spinal anesthesia: the first large series. Minerva Urol Nefrol 70:333–339. https://doi.org/10.23736/S0393-2249.18.02926-0

Publication types

LinkOut - more resources