Relocation of lower pole stone during retrograde intrarenal surgery fails to improve stone free rate

A study was conducted to compare the stone free rate of in situ treatment versus relocation and lithotripsy for lower pole stones of less than 2 cm in size during retrograde intrarenal surgery.

This prospective randomized study was undertaken from June 2019 to May 2020 in patients undergoing retrograde intrarenal surgery for lower pole renal stones less than 2 cm in diameter. Patients were randomized into the In situ lithotripsy Group and the Relocation lithotripsy Group. In situ lithotripsy group underwent laser lithotripsy in the lower pole without relocation of calculus, and the relocation lithotripsy group had their stones relocated to a favourable location using a tipless nitinol basket followed by laser lithotripsy. The laser lithotripsy was achieved using Holmium:YAG laser ( 120Watt) with 200 µm laser fiber. Double J stent was placed in all the patients at the end of the procedure. Patient demographics, stone characteristics, operative outcomes and complications were evaluated. Stone free rate was determined at one month postoperatively with X-ray and ultrasound KUB.

The Results of the study are:

• Sixty-eight patients were included in the study, in situ group (n=35) and relocation group (n=33).
• The mean stone size and stone density were similar between the groups.
• The total operative duration, lasing duration and total energy used were similar between the groups. At one month follow up complete stone free rate was obtained 85.7% and 91% in situ lithotripsy and relocation lithotripsy group respectively (p=0.506).

Thus, relocation followed by subsequent laser lithotripsy was associated with similar stone free rate as in situ laser lithotripsy for lower pole renal calculus less than 2 cm in diameter during retrograde intrarenal surgery using Ho:YAG laser.

Reference:

Dr. Anil Shrestha, Dr. Baikuntha Adhikari, and Dr. Arvind Kumar Shah. Does relocation of lower pole stone during retrograde intrarenal surgery improve stone free rate? : A prospective randomized study. Journal of Endourology. https://doi.org/10.1089/end.2022.0050