Castellani Daniele, Traxer Olivier, Ragoori Deepak, Galosi Andrea Benedetto, De Stefano Virgilio, Gadzhiev Nariman, Tanidir Yiloren, Inoue Takaaki, Emiliani Esteban, Hamri Saeed Bin, Lakmichi Mohamed Amine, Vaddi Chandra Mohan, Heng Chin Tiong, Soebhali Boyke, More Sumit, Sridharan Vikram, Gökce Mehmet Ilker, Tursunkulov Azimdjon N, Ganpule Arvind, Pirola Giacomo Maria, Naselli Angelo, Aydin Cemil, Ramón de Fata Chillón Fernando, Mendoza Catalina Solano, Candela Luigi, Chew Ben Hall, Somani Bhaskar Kumar, Gauhar Vineet
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy.
Department of Urology AP-HP, Sorbonne University, Tenon Hospital, Paris, France.
Eur Urol Open Sci. 2023 Apr 30;52:51-59. doi: 10.1016/j.euros.2023.03.018. eCollection 2023 Jun.
Bilateral kidney stones are commonly treated in staged procedures.
To evaluate outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones.
Data from adults who underwent bilateral RIRS in 21 centers were retrospectively reviewed (from January 2015 to June 2022). The inclusion criteria were unilateral/bilateral symptomatic bilateral stone(s) of any size/location in both kidneys and bilateral stones on follow-up with symptom/stone progression. Stone-free rate (SFR) was defined as absence of any fragment >3 mm at 3 mo.
Continuous variables are presented as medians and 25-75th percentiles. A multivariable logistic regression analysis was performed to evaluate independent predictors of sepsis and bilateral SFR.
A total of 1250 patients were included. The median age was 48.0 (36-61) yr. Of the patients, 58.2% were prestented. The median stone diameter was 10 mm on both sides. Multiple stones were present in 45.3% and 47.9% of the left and right kidneys, respectively. Surgery was stopped in 6.8% of cases. The median surgical time was 75.0 (55-90) min. Complications were transient fever (10.7%), fever/infection needing prolonged stay (5.5%), sepsis (2%), and blood transfusion (1.3%). Bilateral and unilateral SFRs were 73.0% and 17.4%, respectively. Female (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.18-7.49, = 0.02), no antibiotic prophylaxis (OR 5.99, 95% CI 2.28-15.73, < 0.001), kidney anomalies (OR 5.91, 95% CI 1.96-17.94, < 0.001), surgical time ≥100 min (OR 2.86, 95% CI 1.12-7.31, = 0.03) were factors associated with sepsis. Female (OR 1.88, 95% CI 1.35-2.62, < 0.001), bilateral prestenting (OR 2.16, 95% CI 1.16-7.66, = 0.04), and the use of high-power holmium:YAG laser (OR 1.63, 95% CI 1.14-2.34, < 0.01) and thulium fiber laser (OR 2.50, 95% CI 1.32-4.74, < 0.01) were predictors of bilateral SFR. Limitations were retrospective study and no cost analysis.
SSB-RIRS is an effective treatment with an acceptable complication rate in selected patients with kidney stones.
In this large multicenter study, we looked at outcomes after same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) for renal stones in a large cohort. We found that SSB-RIRS was associated with acceptable morbidity and good stone clearance after a single session.
双侧肾结石通常采用分期手术治疗。
评估同期双侧逆行肾内手术（SSB-RIRS）治疗肾结石后的疗效。
设计、地点和参与者：回顾性分析了21个中心接受双侧RIRS的成人患者数据（2015年1月至2022年6月）。纳入标准为双侧肾脏存在任何大小/位置的单侧/双侧有症状结石，以及随访时出现症状/结石进展的双侧结石。无石率（SFR）定义为术后3个月无任何直径>3 mm的结石碎片。
连续变量以中位数和第25-75百分位数表示。进行多变量逻辑回归分析以评估脓毒症和双侧SFR的独立预测因素。
共纳入1250例患者。中位年龄为48.0（范围36-61）岁。其中58.2%的患者曾接受过支架置入。双侧结石的中位直径均为10 mm。左、右肾分别有45.3%和47.9%存在多发结石。6.8%的病例手术中止。中位手术时间为75.0（55-90）分钟。并发症包括短暂发热（10.7%）、发热/感染需延长住院时间（5.5%）、脓毒症（2%）和输血（1.3%）。双侧和单侧SFR分别为73.0%和17.4%。女性（比值比[OR]2.97，95%置信区间[CI]1.18-7.49，P = 0.02）、未进行抗生素预防（OR 5.99，95%CI 2.28-15.73，P < 0.）、肾脏异常（OR 5.91，95%CI 1.96-17.94，P < 0.001）、手术时间≥1（OR 2.86，95%CI 1.12-7.31，P = 0.03）是与脓毒症相关的因素。女性（OR 1.88，95%CI 1.35-2.62，P < 0.001）、双侧支架置入（OR 2.16，95%CI 1.16-7.66，P = 0.04）、使用高功率钬：钇铝石榴石激光（OR 1.63，95%CI 1.14-2.34，P < 0.01）和铥光纤激光（OR 2.50，95%CI 1.32-4.74，P < 0.01）是双侧SFR的预测因素。局限性在于为回顾性研究且未进行成本分析。
对于部分肾结石患者，SSB-RIRS是一种有效的治疗方法，并发症发生率可接受。
在这项大型多中心研究中，我们观察了同期双侧逆行肾内手术（SSB-RIRS）治疗大量肾结石患者后的疗效。我们发现SSB-RIRS单次手术后的发病率可接受且结石清除效果良好。
