T-Tilt position effective for stone-free rates in retrograde intrarenal surgery, study finds

New York: A prospective study by Christine W. Liaw and team revealed that the T-Tilt patient position in patients undergoing retrograde intrarenal surgery (RIRS) is associated with higher stone free-rates. This implies that modifying the position of the patients during the surgery improves stone-free rates. The findings of the study are published in The Journal of Urology.

Retrograde intrarenal surgery is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. The increase in the RIRS has been accompanied by the increase in complications most important being smaller fragments. 

Dr. Liaw and colleagues aimed to investigate a modified patient position to increase stone-free rate by analyzing presence of residual fragments. Standard position was T-Tilt position (15° Trendelenburg and 15° airplane away from the surgical side kidney) in a prospective, randomized study.

The patients were randomized into the standard or T-Tilt position. Demographics, comorbidities and operative parameters were collected. Stone-free rate was determined with renal ultrasound and x-ray at 1-month followup. Postoperative complications were recorded up to 1 month. Variables were compared using Kruskal-Wallis test for continuous variables and chi-square test for categorical variables. A total of 138 patients were analyzed out of which 75 were standard patients and 63 were T-Tilt patients

The results of the study were:

• Both the groups had similar patient and stone factors. The most common stone position was the lower pole (68.0% standard, 74.6% T-Tilt).

• Stone-free rates were significantly different: standard position was 76.7% and T-Tilt position was 92.1%.

• Stone-free rates for isolated lower pole stones were found to be significantly different as well.

• Standardposition was 68.2% and T-Tilt position was 95.6%. Clavien-Dindo scores did not differ significantly.

Liaw and team concluded that "The T-Tilt patient position was associated with higher stone-free rates. It is an atraumatic, cost-effective technique. These results suggest that modifying patient positioning during retrograde intrarenal surgery improves stone-free rates."

Reference: https://doi.org/10.1097/JU.0000000000001948