Ünal ÖZTEKİN, MEHMET CANİKLİOĞLU, Sercan SARI, Abdullah GÜREL, Volkan SELMİ, Levent IŞIKAY, Fatih ATAÇ

IMPACT OF PREOPERATIVE STENT ON RETROGRADE INTRARENAL SURGERY OUTCOMES

Objective: Retrograde intrarenal surgery is commonly indicated for the treatment of 10-20 mm ureteral and renal stones. Sometimes, primary retrograde endoscopy is not possible. Pre-stenting may facilitate passage of ureteroscope or ureteral access sheath in these cases. This study aimed to assess the impact of preoperative ureteral stenting on the outcomes of retrograde endoscopic stone surgery. Material and Methods: A database of patients who underwent retrograde intrarenal surgery for proximal ureteral or renal calculi between January 2015 and October 2018 was analyzed. Sixty-seven patients had a ureteral stent preoperatively (Group 1). Control group (Group 2) consisting of 67 patients were chosen among the rest of the database with similar characteristics. Preoperative, intraoperative and postoperative data of two groups were compared. Results: There were no statistically significant differences in demographic and preoperative features between the two groups except for previous stone surgery. Overall complication rate, stone free rate, operation time and postoperative double J placement rate were similar between two groups. Most of the complications were low grade for both groups. In group 2 ureteral stricture was seen in two patients. Conclusion: Retrograde intrarenal surgery, Preoperative stent, Stone, Stone free rate, Double J stent.

Preoperatif Stent Uygulamasının Retrograd İntrarenal Cerrahi Sonuçları Üzerine Etkisi

Amaç: Retrograd intrarenal cerrahi genellikle 10-20 mm boyutunda üreteral ve renal taşların tedavisinde endikedir. Bazen primer retrograd endoskopi mümkün olmayabilir. Bu durumlarda prestent uygulaması üreteroskop veya üreteral akses kılıfın geçişini kolaylaştırabilir. Bu çalışmada, preoperatif üreter stent uygulamasının, retrograd endoskopik taş cerrahisi sonuçları üzerine etkisi değerlendirilmiştir. Gereç ve Yöntemler: Ocak 2015-Ekim 2018 tarihleri arasında proksimal üreter veya intrarenal taşı olan hastalarda uygulanan retrograd intrarenal cerrahi sonuçları analiz adildi. Ameliyat öncesi 67 hastada üreteral stent vardı (Grup 1). Veri tabanında benzer özellikleri olan 67 hasta seçilerek kontrol grubu (Grup 2) oluşturuldu. İki grubun preoperatif, intraoperatif ve postoperatif verileri karşılaştırıldı. Bulgular: Geçirilmiş taş cerrahisi dışında iki grup arasında demografik ve preoperatif veriler arasında istatistiksel olarak anlamlı fark yoktu. Genel komplikasyon taşsızlık, ameliyat süresi ve postoperatif çift J yerleştirme oranı iki grup arasında benzerdi. Her iki grupta çoğunlukla minör komplikasyonlar görüldü. Grup 2'de iki hastada üreteral darlık görüldü. Sonuç: Retrograd intrarenal taş cerrahisi için preoperatif stent uygulamasının, cerrahi sonuçlar üzerine etkisi görülmemektedir.

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1. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, Liatsikos E et al. Trends of 'urolithiasis: interventions, simulation, and laser technology' over the last 16 years (2000-2015) as published in the literature (PubMed): a systematic review from European section of Uro-technology (ESUT). World J Urol. 2017;35(11):1651-58.

2. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M et al EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69(3):475–82.

3. Rubenstein RA, Zhao LC, Loeb S, Shore DM, Nadler RB. Prestenting improves ureteroscopic stone-free rates. J Endourol. 2007;21(11):1277-80.

4. Traxer O and Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013;189(2):580-4.

5. Benoit L, Spie R, Favoulet P, Cheynel N, Kretz B, Gouy S et al. Management of ureteral injuries. Ann Chir. 2005;130(8):451-7.

6. Pereira BM, Ogilvie MP, Gomez-Rodriguez JC, Ryan ML, Pena D, Marttos AC et al. A review of ureteral injuries after external trauma. Scand J Trauma Resusc Emerg Med. 2010;18:6. Doi: 10.1186/1757-7241-18-6.

7. Lee MH, Lee IJ, Kim TJ, Lee SC, Jeong CW, Hong SK et al. The effect of short-term preoperative ureteral stenting on the outcomes of retrograde intrarenal surgery for renal stones. World J Urol. 2019;37(7):1435-40.

8. Hubert KC, Palmer JS. Passive dilation by ureteral stenting before ureteroscopy: eliminating the need for active dilation. J Urol. 2005;174(3):1079-80.

9. Jones BJ, Ryan PC, Lyons O, Grainger R, McDermott TE, Butler MR. Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy. Br J Urol. 1990;66(3):254-6.

10. Chu L, Sternberg KM, Averch TD. Preoperative stenting decreases operative time and reoperative rates of ureteroscopy. J Endourol. 2011;25(5):751-4.

11. Perlmutter AE, Talug C, Tarry WF, Zaslau S, Mohseni H, Kandzari SJ. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. J Urol. 2007;71(2):214–17.

12. Zhang J, Xu C, He D, Lu Y, Hu H, Qin B et al. Flexible ureteroscopy for renal stone without preoperative ureteral stenting shows good prognosis. PeerJ. 2016;4:e2728.

13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.

14. Netsch C, Knipper S, Bach T, Herrmann TRW, Gross AJ. Impact of preoperative ureteral stenting on stone-free rates of ureteroscopy for nephroureterolithiasis: a matched-paired analysis of 286 patients. Urology. 2012;80(6):1214-9.

15. Ather MH, Paryani J, Memon A, Sulaiman MN. A 10-year experience of managing ureteric calculi: changing trends towards endourological intervention-is there a role for open surgery? BJU Int. 2001;88(3):173-7.

16. Auge BK, Sarvis JA, L’Esperance JO, Preminger GM. Practice patterns of ureteral stenting after routine ureteroscopic stone surgery: a survey of practice urologists. J Endourol. 2007;21(11):1287-91.

17. Shields JM, Bird VG, Graves R, Gomez-Marin O. Impact of preoperative ureteral stenting on outcome of ureteroscopic treatment for urinary lithiasis. J Urol. 2009;182(6):2768-74.

18. Lumma, PP, Schneider P, Strauss A, Plothe KD, Thelen P, Ringert RH et al. Impact of ureteral stenting prior to ureterorenoscopy on stone-free rates and complications. World J Urol. 2013;31(4):855-9.

19. Assimos D, Crisci A, Culkin D, Xue W, Roelofs A, Duvdevani M et al. Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study. BJU Int. 2016;117(4):648-54.

20. Jessen JP, Breda A, Brehmer M, Liatsikos EN, Millan Rodriguez F, Osther PJ et al. International collaboration in endourology: Multicenter evaluation of prestenting for ureterorenoscopy. J Endourol. 2016;30(3):268-73.

21. Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K. EAU guidelines on urolithiasis. 2018. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2018-large-text.pdf.

22. Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde ıntrarenal surgery: The “resorlu-unsal stone score”. Urology. 2012;80(3):512-8.

23. Tonyalı S, Yılmaz M, Karaaslan M, Ceylan C, Işıkay L. Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones. Turk J Urol. 2018;44(6):473-7.