Operative outcomes 24 hours after retrograde intrarenal surgery for solitary renal calculi using a flexible and navigable suction ureteral access sheath. A prospective global multicenter study by the European Association of Urology Section on Urolithiasis

Suction techniques showed potential to improve outcomes of retrograde intra-renal surgery (RIRS). We assessed the 24-hour stone-free rate (SFR) and complications after RIRS using flexible and navigable suction ureteral access sheaths (FANS-UAS). Sixteen centers prospectively contributed to data (Aug...

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Published in:	Minerva urology and nephrology Vol. 76; no. 5; p. 625
Main Authors:	Gauhar, Vineet, Traxer, Olivier, Castellani, Daniele, Fong, Khi Y, Bin Hamri, Saeed, Gökce, Mehmet I, Gadzhiev, Nariman, Corrales, Mariela, Malkhasyan, Vigen, Ragoori, Deepak, Soebhali, Boyke, Tan, Karl, Chai, Chu A, Tursunkulov, Azimdjon N, Tanidir, Yiloren, Persaud, Satyendra, Elshazly, Mohamed, Kamal, Wissam, Tefik, Tzevat, Shrestha, Anil, Chew, Ben H, Lakmichi, Mohamed A, Galosi, Andrea B, Tiong, Heng C, Seitz, Christian, Somani, Bhaskar K
Format:	Journal Article
Language:	English
Published:	Italy 01-10-2024
Subjects:	Adult Equipment Design Europe - epidemiology Female Humans Kidney Calculi - diagnostic imaging Kidney Calculi - surgery Male Middle Aged Postoperative Complications - epidemiology Postoperative Complications - etiology Prospective Studies Suction - instrumentation Time Factors Treatment Outcome Ureter - diagnostic imaging Ureter - surgery Urologic Surgical Procedures - adverse effects Urologic Surgical Procedures - instrumentation Urologic Surgical Procedures - methods Europe
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Summary:	Suction techniques showed potential to improve outcomes of retrograde intra-renal surgery (RIRS). We assessed the 24-hour stone-free rate (SFR) and complications after RIRS using flexible and navigable suction ureteral access sheaths (FANS-UAS). Sixteen centers prospectively contributed to data (August 2023-October 2023). Inclusion criteria: age ≥18 years, single renal stone, pre and 24-hour post-RIRS CT scan. Exclusion criteria were: ureteral stone, anomalous kidney, multiple stones. SFR was divided into: 1) grade A - no fragments; 2) grade B - fragments ≤2 mm; 3) grade C - fragments 2.1-4 mm; and 4) grade D - fragments >4 mm. A multivariable logistic regression analysis model was performed to assess factors associated with the odds of having grade A stone-free status. Data are expressed as median (interquartile range), absolute numbers and frequencies, odds ratio (OR), and 95% confidence interval (CI). One hundred forty-two patients with a median age of 52 years (40-61) were enrolled. 61.3% were males. Median stone volume was 1165 mm (656-1936). Median operative time was 48.5 (36.25-71.75) min. Transient fever (37°C-37.5°C) occurred in 10 (7%) patients. No sepsis case occurred. 96.5% of patients were stone-free (Grade A+B). Grade A SFR was 52.8%. All patients were discharged within 48 hours. Bone window (OR 3.156 95% CI 1.177-9.130, P=0.027) was the only factor significantly associated with higher odds of 100% SFR, while stone volume (OR 0.999, 95% CI 0.999-1.000, P=0.007) was significantly associated with lower odds. Imaging and clinical evidence demonstrate excellent perioperative outcomes just 24 hours post RIRS with FANS-UAS. The technique demonstrates a good safety profile, ability for immediate high SFR, and a low rate of infective complications.
ISSN:	2724-6442
DOI:	10.23736/S2724-6051.24.05961-5