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Digital Videoscopic Retrograde Intrarenal Surgeries for Renal Stones: Time-to-Maximal Stone Length Ratio Analysis

 Jae Yong Jeong  ;  Jong Chan Kim  ;  Dong Hyuk Kang  ;  Joo Yong Lee 
 YONSEI MEDICAL JOURNAL, Vol.59(2) : 303-309, 2018 
Journal Title
Issue Date
Demography ; *Endoscopy ; Female ; Humans ; Kidney/*surgery ; Kidney Calculi/*surgery ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Operative Time ; Postoperative Period ; Time Factors ; Treatment Outcome
Urinary calculi ; endoscopes ; treatment outcome
PURPOSE: To investigate 100 consecutive cases of videoscopic retrograde intrarenal surgery (RIRS) by a single surgeon and to evaluate factors associated with stone-free status and the learning curve thereof. MATERIALS AND METHODS: We analyzed the results of videoscopic RIRS in 100 patients who underwent primary treatment for renal stones from January 2015 to August 2016. Videoscopic RIRS were performed with URF-V and URF-V2 flexible video uteroscopes (Olympus) or a Flex-Xc flexible ureterorenoscope (KARL STORZ). Non-contrast computed tomography was taken at 3 months postoperatively to confirm the absence of stones. The stone characteristics included the location, maximal stone length (MSL), stone heterogeneity index (SHI), and mean stone density (MSD). Fragmentation efficacy was calculated as operative time (min) divided by removed MSL (mm), and was evaluated in the sequential order of operations. RESULTS: The mean age of the total patient was 60.0+/-14.0 years. The mean MSL was 13.1+/-6.2 mm. The average MSD was 734.2+/-327.6 Hounsfield unit (HU) and the SHI was 241.0+/-120.0 HU. The mean operation time was 65.1+/-45.7 min considering each renal unit. The stone-free rate at 3 months post-surgery was 87%. The estimated cut-off of the time-to-MSL ratio below 5 min/mm was 50. Multivariate analyses indicated a lower MSD [odds ratio (OR): 0.998; 95% confidence interval (CI): 0.996-0.999; p=0.047) and the last 50 cases (OR: 5.408, 95% CI: 1.337-30.426; p=0.030) as independent predictors of stone-free status after videoscopic RIRS. CONCLUSION: Low MSDs and the last 50 cases were significant predictors of stone-free rate in videoscopic RIRS.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Dong Hyuk(강동혁)
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
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