Mesquita Sofia, Mendes Gonçalo, Marques-Monteiro Miguel, Rocha Maria Alexandra, Madanelo Mariana, Fraga Avelino, Cavadas Vítor
Department of Urology, Unidade Local de Saúde de Santo António, Centro Hospitalar Universitário Do Porto, 8th floor, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal.
Int Urol Nephrol. 2025 May;57(5):1473-1480. doi: 10.1007/s11255-024-04343-8. Epub 2024 Dec 28.
The primary aim of stone treatment is to achieve stone-free status. Residual fragments can cause stone growth, recurrence, urinary tract infections, and ureteric obstruction. Our goal was to describe the natural history of stone burden after retrograde intrarenal surgery (RIRS) based on stone-free status (SFS), evaluating stone growth and stone-events.
We retrospectively reviewed data from patients who underwent RIRS at a tertiary care center between October 2014 and September 2019. The stone burden was assessed by measuring the maximum diameter (mm) and volume (mm). Patients were divided into four groups according to SFS-(A) absolute stone-free, no stones on non-contrast-enhanced computed tomography (NCCT); (B) relative stone-free with ≤ 2 mm fragments, (C) relative stone-free with 2.1-4 mm fragments, and (D) residual fragments > 4 mm. Our main outcomes were stone growth over time (defined as an increase in diameter compared to first postoperative measurement) and incidence of stone-related events (pain or additional intervention to treat symptoms, obstruction, or removing fragments).
A total of 98 patients were included in the study-42 were classified as absolute stone-free (Group A), 20 were categorized as relatively stone-free (Groups B and C), and 36 had a residual stone burden with fragments larger than 4 mm (Group D) on postoperative NCCT. There was a significant difference in the number of stones among the groups (p < 0.001). The pre-operative stone volume differed significantly among the groups (p = 0.003). Group A had the lowest median total stone volume (551.3 mm). Twenty patients (20.4%) developed stone-events during a mean follow-up period of 62.3 months (± 26.0). Stone-event-free survival differed significantly between the groups (p = 0.028), with Group D demonstrating a higher incidence of stone-related events post-RIRS compared to the other groups. Sixteen patients (16.3%) had renal colic requiring a hospital visit across all groups. Thirteen patients (13.3%) required re-intervention (3 patients belonged to Group A, 1 to Group B, 2 to Group C, and 7 to Group D).
Group D shows a higher rate of stone-related events post-RIRS. Ensuring complete stone-free status after RIRS is crucial for treatment success. Other factors should be considered in the management, including ensuring compliance with general preventive measures and stone-specific pharmacological treatments to prevent recurrence.
结石治疗的主要目标是实现无结石状态。残留碎片可导致结石生长、复发、尿路感染和输尿管梗阻。我们的目标是根据无结石状态（SFS）描述逆行肾内手术（RIRS）后结石负荷的自然史，评估结石生长和结石相关事件。
我们回顾性分析了2014年10月至2019年9月在一家三级医疗中心接受RIRS治疗的患者的数据。通过测量最大直径（mm）和体积（mm）来评估结石负荷。根据SFS将患者分为四组：（A）绝对无结石，非增强计算机断层扫描（NCCT）上无结石；（B）相对无结石，碎片≤2mm；（C）相对无结石，碎片为2.1 - 4mm；（D）残留碎片>4mm。我们的主要结局是结石随时间的生长（定义为与术后首次测量相比直径增加）和结石相关事件的发生率（疼痛或为治疗症状、梗阻或清除碎片而进行的额外干预）。
本研究共纳入98例患者，42例被分类为绝对无结石（A组），20例被分类为相对无结石（B组和C组），36例术后NCCT显示有残留结石负荷且碎片大于4mm（D组）。各组结石数量存在显著差异（p<0.001）。术前结石体积在各组之间也有显著差异（p = 0.003）。A组的总结石体积中位数最低（551.3mm）。在平均62.3个月（±26.0）的随访期内，20例患者（20.4%）发生了结石相关事件。各组之间无结石相关事件生存情况有显著差异（p = 0.028），与其他组相比，D组在RIRS后结石相关事件的发生率更高。所有组中有16例患者（16.3%）因肾绞痛需要住院治疗。13例患者（13.3%）需要再次干预（3例属于A组，1例属于B组，2例属于C组，7例属于D组）。
D组在RIRS后显示出较高的结石相关事件发生率。确保RIRS后完全无结石状态对于治疗成功至关重要。在管理中应考虑其他因素，包括确保遵守一般预防措施和特定结石的药物治疗以预防复发。
