Second-Look Flexible Ureterorenoscopy: A Technique Proposal to Achieve
Real Stone Free Status
Abstract
Introduction Residual stone fragments remain a challenging topic for
urologists following retrograde intrarenal surgery (RIRS). This study
investigates the effectiveness of second-look flexible ureterorenoscopy
(URS) to achieve a true stone-free status and decrease stone-related
events. Material and Method A total of 176 consecutive patients treated
with RIRS for kidney stones were included in the study. Patients were
divided into two groups, group 1 receiving the standard of care (n=51)
and group 2 receiving second-look flexible URS (n=125). In all cases,
one or more calyceal stones of 1 to 4 mm were extracted with a basket at
the time of stent removal. Unless earlier intervention was necessary,
patients were followed up every six months to determine if they had
experienced SREs. Results The mean follow-up time for the whole group
was 21±11.1 months. The mean number of stones in group 1 and group 2 was
1.25±0.11 and 1.56±0.19, respectively. Postoperative stone-free rate
after RIRS for group 1 and group 2 were 37.25% (n=19/51) and 40.8%
(n=51/125), respectively. The SFR improved to 93.6% (n=117/125) in
group 2. Multivariable analysis showed that type of intervention, stone
size, and body mass index were independent prognostic factors for SREs.
When group 2 was taken as a reference, the odds ratio for SREs was 8.48
(95% CI: 2.95–24.42) in group 1. Conclusion This study found that
second-look flexible URS increased the SFRs and diminished the number of
SREs. We propose performing second-look flexible URS following RIRS in
the presence or suspicion of RSFs to provide better treatment results,
less radiation exposure, and greater patient satisfaction. Key Words
Retrograde Intrarenal Surgery, Flexible Ureteroscopy, Stone-free Rate,
Residual stone Fragments, Stone-Related Event, Second-look Flexible
Ureteroscopy.