Open Access

ARTICLE

Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?

Guido Giusti¹, Silvia Proietti¹, Lorenzo G. Luciani², Roberto Peschechera¹, Antonella Giannantoni³, Gianluigi Taverna¹, Giuseppe Sortino^1,4, Pierpaolo Graziotti¹

1 Department of Urology, IRCCS Humanitas Clinical and Research Center, Milan, Italy
2 Department of Urology, Santa Chiara Hospital, Trento, Italy
3 Department of Urology, Santa Maria della Misericordia Hospital, Perugia, Italy
4 Department of Urology, G. Rodolico Hospital, Catania, Italy
Address correspondence to Dr. Silvia Proietti, Department of Urology, IRCCS Humanitas Clinicaland Research Center, Via Manzoni, 56, 20089, Milan, Italy

Canadian Journal of Urology 2014, 21(2), 7207-7212.

Abstract

Introduction: Major kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones >2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification.
Materials and methods: By retrospective analysis, we identified a total of 162 patients who were affected by stones greater than 2 cm in diameter and who had undergone RIRS. We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications.
Results: The mean stone size was 2.7 cm ± 0.6 cm. The primary, secondary, and tertiary stone-free rates were 66%, 80.9%, and 87.7%, respectively. The mean number of procedures per patient was 1.48. The complication rates according to the Clavien-Dindo classification were Clavien I in 20.4% of patients, Clavien II in 0%, Clavien III in 4.9%, Clavien IV in 0.6%, and Clavien V in 0%.
Conclusions: As an alternative to standard procedures for the treatment of renal calculi greater than 2 cm in diameter, RIRS is safe and effective, with a low complication rate.

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