Document Type : Original Article

Authors

1 Department of urology, Nizams Institute of Medical sciences, Hyderabad, Telangana, India

2 Department of urology , Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.

3 Department of urology , Nizams Institute of Medical Sciences. Hyderabad, Telangana, India

4 Department of Urology, Nizams Institute of Medical Sciences , Hyderabad , Telangana ,India.

5 Department of urology , Nizams Institute of Medical Sciences. Hyderabad, Telangana, India,

Abstract

Background: This study evaluated the accuracy of the R.I.R.S scoring system (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) in predicting the stone-free rate (SFR) post RIRS. Methods: This retrospective study was conducted in 50 patients aged 18-65 years undergoing RIRS for kidney stones in a tertiary institute hospital from February 2022 to June 2023. Medical records were analysed to obtain the the pre-operative investigations, intra-operative findings and post-operative complications and follow up data. The RIRS parameters were also measured to predict stone free rate post RIRS. Results: 38% patients had mild RIRS score (4-5), 60% patients had moderate RIRS score (6-8) and 2% patients had severe RIRS score (9-10). 46 patients (92%) had stone free (SF) status while remaining 4 patients (8%) had residual stone fragments. 22% patients had complications such as fever (18% patients) and urosepsis (4% patients). AUROC for stone burden (mm) and stone density (HU) predicting SF status was 0.989 (p = 0.001) and 0.837 (p = 0.028) respectively. AUROC) for R.I.R.S. Score predicting Complications was 0.8 (p = 0.002) statistically significant. Conclusion: R.I.R.S. scoring system was statistically significant in assessing stone free rate and complications. The higher R.I.R.S. score was associated with more residual stone fragments, lower stone clearance and higher postop complications. Hence R.I.R.S is a reliable and accurate preoperative tool for estimating the probability of stone-free state and complications after RIRS surgery.

Keywords

Main Subjects

  1. Sorokin I, Mamoulakis C, Miyazawa K, et al: Epidemiology of stone disease across the world,World J Urol.2017; 35(9):1301-1320, https://doi.org/10.1007/s00345-017-2008-6

 

2.Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T, Guidelines EAU. On interventional treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82.
https://doi.org/10.1016/j.eururo.2015.07.041.

 

3.Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG, Lingeman JE, Pais VM, Preminger GM, Lipkin ME, et al. A prospective, multi institutional study of flexible Ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol. 2015;193(1):165-9.
https://doi.org/10.1016/j.juro.2014.07.002.

 

4.Skolarikos A, Gross AJ, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B, de la Rosette J. Outcomes of flexible Ureterorenoscopy for solitary renal stones in the CROES URS global study. J Urol. 2015;194(1):137-43. https://doi.org/10.1016/j.juro.2015.01.112.

 

5.. Pearle, M.S., et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol, 2005. 173: 2005.
https://doi.org/10.1097/01.ju.0000158458.51706.56.

 

  1. Srisubat, A., et al. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev, 2014. 11: CD007044. https://doi.org/10.1002/14651858.CD007044.pub3.

 

  1. Preminger, G.M. Management of lower pole renal calculi: shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy. Urol Res, 2006. 34: 108.
    https://doi.org/10.1007/s00240-005-0020-6.

 

  1. Chan, L.H., et al. Primary SWL Is an Efficient and Cost-Effective Treatment for Lower Pole Renal Stones Between 10 and 20 mm in Size: A Large Single Center Study. J Endourol, 2017. 31: 510. https://doi.org/10.1089/end.2016.0825.

 

  1. Geraghty, R., et al. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era. Curr Urol Rep, 2015. 16: 54. https://doi.org/10.1007/s11934-015-0529-3.

 

  1. Hyams, E.S., et al. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol, 2010. 24: 1583. https://doi.org/10.1089/end.2009.0629.

 

  1. Riley, J.M., et al. Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol, 2009. 23: 1395. https://doi.org/10.1089/end.2009.0391.

 

  1. Akman, T., et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012. 109: 1384. https://doi.org/10.1111/j.1464-410X.2011.10691.x.

 

13 . EAU guidelines 2023.uroweb.org guidelines..

 

14.WJ W, Okeke Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol. 2017;14(8):459-469. https://doi.org/10.1038/nrurol.2017.71.

 

15.Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score". Urology. 2012;80(3):512
https://doi.org/10.1016/j.urology.2012.02.072.

 

16.Jung JW, Lee BK, Park YH, Lee S, Jeong SJ, Lee SE, Jeong CW. Modified Seoul National University renal stone complexity score for retrograde intrarenal surgery. Urolithiasis. 2014;42(4):335-40. https://doi.org/10.1007/s00240-014-0650-7.

 

17.Erbin A, Tepeler A, Buldu I, Ozdemir H, Tosun M, Binbay M. External comparison of recent predictive Nomograms for stone-free rate using retrograde flexible Ureteroscopy with laser lithotripsy. J Endourol. 2016; 30(11):1180-4.
https://doi.org/10.1089/end.2016.0473.

 

  1. Thiruchelvam N, Mostafid H, Ubhayakar G. Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting. BJU Int. 2005;95(9):1280-4.
    https://doi.org/10.1111/j.1464-410X.2005.05519.x.

 

19.Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol.  

2013;189(2):580-4.

 

20.Sfoungaristos S, Gofrit ON, Mykoniatis I, Landau EH, Katafgiotis I, Pode D, Constantinides CA, Duvdevani M. External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery. Int Urol Nephrol. 2016;48(8):1247-52.
https://doi.org/10.1007/s11255-016-1311-2.

 

21.Ito H, Sakamaki K, Kawahara T, Terao H, Yasuda K, Kuroda S, Yao M, Kubota Y, Matsuzaki J. Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones. BJU Int 2015;115(3):446-51. https://doi.org/10.1111/bju.12775.

 

  1. Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score."'Urology. 2012;80(3):512-8.
    https://doi.org/10.1016/j.urology.2012.02.072.

 

  1. Erbin A, Tepeler A, Buldu I, Ozdemir H, Tosun M, Binbay M. External comparison of recent predictive Nomograms for stone-free rate using retrograde flexible Ureteroscopy with laser lithotripsy. J Endourol. 2016; 30(11):1180-4. https://doi.org/10.1089/end.2016.0473.

 

  1. Xiao Y, Li D, Chen L, et al. The R.I.R.S. scoring system: An innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery. BMC Urol. 2017; 17: 105.
    https://doi.org/10.1186/s12894-017-0297-0.

 

  1. Wang C, Wang ST, Wang X, Lu J. External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery. BMC Urol. 2021; 21: 33.
    https://doi.org/10.1186/s12894-021-00801-y.