Page 1 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
1
Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience Running title: RIRS FOR STONES IN SOLITARY KIDNEY Xiaofeng Gao &, Yonghan Peng &, Xiaolei Shi &, Ling Li, Tie Zhou, Bin Xu, Yinghao Sun#. Department of Urology, Changhai Hospital, The Second Military Medical University, 168 Changhai Road, Shanghai 200433, P. R. China &: co-first authors Xiaofeng Gao, M.D Tel: +86 13601600968 E-mail: [email protected] Yonghan Peng, M.D. Tel: +86 13917386896 E-mail: [email protected] Xiaolei Shi, M.D. Tel: +86 1590755789 E-mail: [email protected] Ling Li, M.D. Tel: +86 18019766513 E-mail: [email protected] Tie Zhou, M.D. Tel: +86 13918360523 E-mail: [email protected] Bin Xu, M.D. Tel: +86 13386271601 E-mail: [email protected] #: All correspondences should be addressed to Yinghao Sun, M.D. Department of Urology, Changhai Hospital The Second Military Medical University 168 Changhai Road Shanghai 200433, P. R. China Tel: +86 21 81873409; Fax: +86 21 35030006; E-mail: [email protected] Conflict of interest: No Sources of support: No
1
Page 2 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
2 Abstract Purpose: The management of urolithiasis in patients with a solitary kidney is challenging for endourologists. This study was aimed at evaluating the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of renal stones in such patients. Patients and Methods: Between January 2010 and January 2014, we enrolled 45 patients who had a solitary kidney and underwent RIRS and holmium: yttrium-aluminum-garnet lithotripsy for the management of renal stones. We collected data pertaining to the preoperative patient characteristics, stone dimensions, and postoperative outcomes. Results: Sixty-eight procedures were performed in all. The mean stone diameter was 1.84±0.19 cm (range: 0.5–6.0 cm), and the mean operative time, 76.4±40.14 min (range: 18–190 min). The percentages of patients free of renal stones at the initial and final procedures were 64.44% and 93.33%, respectively. The mean number of procedures required for the patients with renal stones of diameters ≥20 mm and 2 cm, patients undergoing RIRS may require multiple procedures to achieve a stone-free status.
Disclosure Statement No competing financial interest exist.
15
Page 16 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
16 References 1.
Michel MS, Trojan L and Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51: 899-906.
2.
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, Sancaktutar AA, Tepeler A, Bozkurt OF and Oztuna D: Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 2013; 31: 1581-6.
3.
Hyams ES, Munver R, Bird VG, Uberoi J and Shah O: Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol 2010; 24: 1583-8.
4.
Breda A, Ogunyemi O, Leppert JT and Schulam PG: Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009; 55: 1190-6.
5.
Breda A, Ogunyemi O, Leppert JT, Lam JS and Schulam PG: Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater--is this the new frontier? J Urol 2008; 179: 981-4.
6.
Kruck S, Anastasiadis AG, Herrmann TR, Walcher U, Abdelhafez MF, Nicklas AP, Holzle L, Schilling D, Bedke J, Stenzl A et al.: Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World J Urol 2013; 31: 1555-61.
7.
Clark DL, Connors BA, Evan AP, Handa RK and Gao S: Effect of shock wave number on renal oxidative stress and inflammation. BJU Int 2011; 107: 318-22.
8.
Schnabel MJ, Gierth M, Chaussy CG, Dotzer K, Burger M and Fritsche HM: Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments. Urolithiasis, 2014.
9.
Lee HY, Yang YH, Shen JT, Jang MY, Shih PM, Wu WJ, Huang CH, Chou YH and Juan YS: Risk factors survey for extracorporeal shockwave lithotripsy-induced renal hematoma. J Endourol 2013; 27: 763-7, 2013.
10.
Wong KA, Sahai A, Patel A, Thomas K, Bultitude M and Glass J: Is percutaneous nephrolithotomy in solitary kidneys safe? Urology 2013; 82: 1013-6, 2013.
11.
Bucuras V, Gopalakrishnam G, Wolf JS, Jr., Sun Y, Bianchi G, Erdogru T and de la Rosette J: The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol 2012; 26: 336-41.
12.
Akman T, Binbay M, Tekinarslan E, Ozkuvanci U, Kezer C, Erbin A, Berberoglu Y and Yaser-Muslumanoglu A: Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience. Urology 2011; 78: 272-6.
13.
El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR and El-Kappany HA: Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007; 177: 576-9.
14.
Canes D, Hegarty NJ, Kamoi K, Haber GP, Berger A, Aron M and Desai MM: Functional outcomes following percutaneous surgery in the solitary kidney. J Urol 2009; 181: 154-60.
15.
Turna B, Stein RJ, Smaldone MC, Santos BR, Kefer JC, Jackman SV, Averch TD and Desai MM: Safety and efficacy of flexible ureterorenoscopy and holmium:YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol 2008; 179: 1415-9. 16
Page 17 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
17 16.
Akman T, Binbay M, Ozgor F, Ugurlu M, Tekinarslan E, Kezer C, Aslan R and Muslumanoglu AY: Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int 2012; 109: 1384-9.
17.
Atis G, Gurbuz C, Arikan O, Kilic M, Pelit S, Canakci C, Gungor S and Caskurlu T: Retrograde intrarenal surgery for the treatment of renal stones in patients with a solitary kidney. Urology 2013; 82: 290-4.
18.
Schwalb DM, Eshghi M, Davidian M and Franco I: Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study. J Urol 1993; 149: 1576-85.
19.
Jung H, Norby B, Frimodt-Moller PC and Osther PJ: Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 2008; 54: 1404-13.
20.
Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW and Preminger GM: Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004; 18: 33-6.
21.
Schatloff O, Lindner U, Ramon J and Winkler HZ: Randomized trial of stone fragment active retrieval versus spontaneous passage during holmium laser lithotripsy for ureteral stones. J Urol 2010; 183: 1031-5.
22.
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: 580-4.
23.
el-Assmy A, el-Nahas AR, Hekal IA, Badran M, Youssef RF and Sheir KZ: Long-term effects of extracorporeal shock wave lithotripsy on renal function: our experience with 156 patients with solitary kidney. J Urol 2008; 179: 2229-32.
24.
Soyupek S, Armagan A, Kosar A, Serel TA, Hoscan MB, Perk H and Oksay T: Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urol Int 2005; 74: 323-5.
25.
Mariani
AJ:
Combined
electrohydraulic
and
holmium:YAG
laser
ureteroscopic
nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 2007; 177: 168-73.
Abbreviations Used RIRS=Retrograde intrarenal surgery PCNL=percutaneous nephrolithotomy SWL=shock-wave lithotripsy fURS=flexible ureteroscopy IVU=intravenous urography CT=computed tomography UAS=ureteral access sheath KUB=plain radiograph of the kidneys, ureters, and bladder
17
Page 18 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
18 Table 1 Demographic and clinical data Patients, n
45
Gender, male/female
29/16
Laterality, left/right
23/22
Age in years, mean±SD (range)
51.04±1.67 (21–74)
Etiology of the solitary kidney, n Contralateral nephrectomy
13
Congenital
7
Function
25
Stone size in cm, mean±SD (range)
1.84±0.19 (0.5–6.0)
Site of stone, n Pelvis
13
Upper calyx
1
Middle calyx
1
Lower calyx
10
Multiple
20
n=number, SD=standard deviation
Demographic and clinical data
18
Page 19 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
19 Table 2 Perioperative and postoperative data Total
Stone diameter, ≥20 mm
Stone diameter,
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
1
Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience Running title: RIRS FOR STONES IN SOLITARY KIDNEY Xiaofeng Gao &, Yonghan Peng &, Xiaolei Shi &, Ling Li, Tie Zhou, Bin Xu, Yinghao Sun#. Department of Urology, Changhai Hospital, The Second Military Medical University, 168 Changhai Road, Shanghai 200433, P. R. China &: co-first authors Xiaofeng Gao, M.D Tel: +86 13601600968 E-mail: [email protected] Yonghan Peng, M.D. Tel: +86 13917386896 E-mail: [email protected] Xiaolei Shi, M.D. Tel: +86 1590755789 E-mail: [email protected] Ling Li, M.D. Tel: +86 18019766513 E-mail: [email protected] Tie Zhou, M.D. Tel: +86 13918360523 E-mail: [email protected] Bin Xu, M.D. Tel: +86 13386271601 E-mail: [email protected] #: All correspondences should be addressed to Yinghao Sun, M.D. Department of Urology, Changhai Hospital The Second Military Medical University 168 Changhai Road Shanghai 200433, P. R. China Tel: +86 21 81873409; Fax: +86 21 35030006; E-mail: [email protected] Conflict of interest: No Sources of support: No
1
Page 2 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
2 Abstract Purpose: The management of urolithiasis in patients with a solitary kidney is challenging for endourologists. This study was aimed at evaluating the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of renal stones in such patients. Patients and Methods: Between January 2010 and January 2014, we enrolled 45 patients who had a solitary kidney and underwent RIRS and holmium: yttrium-aluminum-garnet lithotripsy for the management of renal stones. We collected data pertaining to the preoperative patient characteristics, stone dimensions, and postoperative outcomes. Results: Sixty-eight procedures were performed in all. The mean stone diameter was 1.84±0.19 cm (range: 0.5–6.0 cm), and the mean operative time, 76.4±40.14 min (range: 18–190 min). The percentages of patients free of renal stones at the initial and final procedures were 64.44% and 93.33%, respectively. The mean number of procedures required for the patients with renal stones of diameters ≥20 mm and 2 cm, patients undergoing RIRS may require multiple procedures to achieve a stone-free status.
Disclosure Statement No competing financial interest exist.
15
Page 16 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
16 References 1.
Michel MS, Trojan L and Rassweiler JJ: Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51: 899-906.
2.
Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S, Sancaktutar AA, Tepeler A, Bozkurt OF and Oztuna D: Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 2013; 31: 1581-6.
3.
Hyams ES, Munver R, Bird VG, Uberoi J and Shah O: Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol 2010; 24: 1583-8.
4.
Breda A, Ogunyemi O, Leppert JT and Schulam PG: Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 2009; 55: 1190-6.
5.
Breda A, Ogunyemi O, Leppert JT, Lam JS and Schulam PG: Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater--is this the new frontier? J Urol 2008; 179: 981-4.
6.
Kruck S, Anastasiadis AG, Herrmann TR, Walcher U, Abdelhafez MF, Nicklas AP, Holzle L, Schilling D, Bedke J, Stenzl A et al.: Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World J Urol 2013; 31: 1555-61.
7.
Clark DL, Connors BA, Evan AP, Handa RK and Gao S: Effect of shock wave number on renal oxidative stress and inflammation. BJU Int 2011; 107: 318-22.
8.
Schnabel MJ, Gierth M, Chaussy CG, Dotzer K, Burger M and Fritsche HM: Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments. Urolithiasis, 2014.
9.
Lee HY, Yang YH, Shen JT, Jang MY, Shih PM, Wu WJ, Huang CH, Chou YH and Juan YS: Risk factors survey for extracorporeal shockwave lithotripsy-induced renal hematoma. J Endourol 2013; 27: 763-7, 2013.
10.
Wong KA, Sahai A, Patel A, Thomas K, Bultitude M and Glass J: Is percutaneous nephrolithotomy in solitary kidneys safe? Urology 2013; 82: 1013-6, 2013.
11.
Bucuras V, Gopalakrishnam G, Wolf JS, Jr., Sun Y, Bianchi G, Erdogru T and de la Rosette J: The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: nephrolithotomy in 189 patients with solitary kidneys. J Endourol 2012; 26: 336-41.
12.
Akman T, Binbay M, Tekinarslan E, Ozkuvanci U, Kezer C, Erbin A, Berberoglu Y and Yaser-Muslumanoglu A: Outcomes of percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience. Urology 2011; 78: 272-6.
13.
El-Nahas AR, Shokeir AA, El-Assmy AM, Mohsen T, Shoma AM, Eraky I, El-Kenawy MR and El-Kappany HA: Post-percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007; 177: 576-9.
14.
Canes D, Hegarty NJ, Kamoi K, Haber GP, Berger A, Aron M and Desai MM: Functional outcomes following percutaneous surgery in the solitary kidney. J Urol 2009; 181: 154-60.
15.
Turna B, Stein RJ, Smaldone MC, Santos BR, Kefer JC, Jackman SV, Averch TD and Desai MM: Safety and efficacy of flexible ureterorenoscopy and holmium:YAG lithotripsy for intrarenal stones in anticoagulated cases. J Urol 2008; 179: 1415-9. 16
Page 17 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
17 16.
Akman T, Binbay M, Ozgor F, Ugurlu M, Tekinarslan E, Kezer C, Aslan R and Muslumanoglu AY: Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int 2012; 109: 1384-9.
17.
Atis G, Gurbuz C, Arikan O, Kilic M, Pelit S, Canakci C, Gungor S and Caskurlu T: Retrograde intrarenal surgery for the treatment of renal stones in patients with a solitary kidney. Urology 2013; 82: 290-4.
18.
Schwalb DM, Eshghi M, Davidian M and Franco I: Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study. J Urol 1993; 149: 1576-85.
19.
Jung H, Norby B, Frimodt-Moller PC and Osther PJ: Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study. Eur Urol 2008; 54: 1404-13.
20.
Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW and Preminger GM: Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004; 18: 33-6.
21.
Schatloff O, Lindner U, Ramon J and Winkler HZ: Randomized trial of stone fragment active retrieval versus spontaneous passage during holmium laser lithotripsy for ureteral stones. J Urol 2010; 183: 1031-5.
22.
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: 580-4.
23.
el-Assmy A, el-Nahas AR, Hekal IA, Badran M, Youssef RF and Sheir KZ: Long-term effects of extracorporeal shock wave lithotripsy on renal function: our experience with 156 patients with solitary kidney. J Urol 2008; 179: 2229-32.
24.
Soyupek S, Armagan A, Kosar A, Serel TA, Hoscan MB, Perk H and Oksay T: Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urol Int 2005; 74: 323-5.
25.
Mariani
AJ:
Combined
electrohydraulic
and
holmium:YAG
laser
ureteroscopic
nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 2007; 177: 168-73.
Abbreviations Used RIRS=Retrograde intrarenal surgery PCNL=percutaneous nephrolithotomy SWL=shock-wave lithotripsy fURS=flexible ureteroscopy IVU=intravenous urography CT=computed tomography UAS=ureteral access sheath KUB=plain radiograph of the kidneys, ureters, and bladder
17
Page 18 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
18 Table 1 Demographic and clinical data Patients, n
45
Gender, male/female
29/16
Laterality, left/right
23/22
Age in years, mean±SD (range)
51.04±1.67 (21–74)
Etiology of the solitary kidney, n Contralateral nephrectomy
13
Congenital
7
Function
25
Stone size in cm, mean±SD (range)
1.84±0.19 (0.5–6.0)
Site of stone, n Pelvis
13
Upper calyx
1
Middle calyx
1
Lower calyx
10
Multiple
20
n=number, SD=standard deviation
Demographic and clinical data
18
Page 19 of 19
Journal of Endourology Safety and Efficacy of Retrograde Intrarenal Surgery for Renal Stones in Patients with a Solitary Kidney: A Single-center Experience (doi: 10.1089/end.2014.0295) This article has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.
19 Table 2 Perioperative and postoperative data Total
Stone diameter, ≥20 mm
Stone diameter,
