Retrograde intrarenal surgery in patients with high-density stones

Abstract

BACKGROUND: Retrograde intrarenal lithotripsy is a modern method of endoscopic treatment of patients with nephrolithiasis, whereas some aspects of its use remain the subject of discussion. AIM: To reveal the advantages and disadvantages of retrograde intrarenal lithotripsy in patients with nephrolithiasis having high-density calculi. MATERIALS AND METHODS: A retrospective and prospective analysis of treatment of 260 clinical cases of high-density kidney stones by transurethral contact pyelocalicolithotripsy was conducted. In all patients, kidney calculi were diagnosed and detected, ranging in size from 8 to 20 mm (average 15.4 mm) and density from 1105 to 1634 HU. Patients were divided into the main group and control group and further into two subgroups according to the lithotripsy method. The main group underwent transurethral contact pyelocalicolithotripsy according to our improved method and the control group according to the standard method. The main subgroup of ultrasonic lithotripsy and the control subgroup included 80 and 50 patients, respectively. The main subgroup of laser lithotripsy and the control subgroup included 50 and 80 patients, respectively. RESULTS: In 223 (85.8%) patients, it was possible to completely crush the calculi and eliminate them from the urinary tract. The stone-free rate in the main group was 96.9% (126 patients) after the first operation, including 96.2% (n = 77) in the ultrasonic lithotripsy subgroup and 98% (n = 49) in the laser lithotripsy subgroup. In the control group, the SFR value was 74.6% (n = 97), including 72% (n = 36) in the ultrasonic lithotripsy subgroup and 83.2% (n = 61) in the laser lithotripsy subgroup. Intra- and postoperative complications were observed in 74 (28.5%) patients, and none had grade IV and V complications according to the adapted ClavienDindo classification. The frequency of complications was significantly lower in the main group and those who underwent laser lithotripsy. The relationship of postoperative complications with intraoperative damage to the structures of the pelvicalyceal system of the kidney has been established. CONCLUSIONS: Transurethral contact pyelocalicolithotripsy is an effective and relatively safe method of treating patients with nephrolithiasis having high-density calculi. The proposed improved surgical intervention has advantages over traditional methods.