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Comparing Same-Sitting Bilateral vs Unilateral Retrograde Intrarenal Surgery in the Elderly - 17/04/24

Doi : 10.1016/j.urology.2024.02.031 
Chu Ann Chai a, ⁎ , Bhaskar Somani b, Daniele Castellani c, Khi Yung Fong d, Kemal Sarica e, Estaban Emiliani f, William Lay Keat Ong g, Deepak Ragoori h, Mehmet Ilker Gökce i, Nariman Gadzhiev j, Yiloren Tanidir k, Mohamed Amine Lakmichi l, Takaaki Inoue m, Giacomo Maria Pirola n, Jeremy Yuen-Chun Teoh o, Saeed Bin Hamri p, Azimdjon N. Tursunkulov q, Arvind Ganpule r, Ben Hall Chew s, Olivier Traxer t, Vineet Gauhar u
a University Malaya, Department of Surgery Urology Unit, Kuala Lumpur, Malaysia 
b University Hospital Southampton NHS Foundation Trust, Department of Urology, Southampton, United Kingdom 
c Azienda ospedaliero universitaria Ospedali riuniti di Ancona Universita Politecnica delle Marche, Department of Urology, Ancona, Italy 
d Yong Loo Lin School of Medicine National University of Singapore, Faculty of Medicine, Singapore, Singapore 
e Biruni University Medical School, Department of Urology, Istanbul, Turkey 
f Fundacion Puigvert Autónomos University of Barcelona, Department of Urology, Barcelona, Spain 
g Penang General Hospital, Department of Urology, Penang, Malaysia 
h Asian Institute Of Nephrology and Urology, Department of Urology, Hyderabad, India 
i Ankara University School of Medicine, Department of Urology, Ankara, Turkey 
j Saint Petersburg State University Hospital Russia, Department of Urology, St Petersburg, Russia 
k Marmara University School of Medicine, Department of Urology, Istanbul, Turkey 
l University Hospital Mohammed the VIth of Marrakesh, Department of Urology, Marrakesh, Morocco 
m Hara Genitourinary Private Hospital and Kobe University, Department of Urology, Kobe, Japan 
n San Giuseppe Hospital, Department of Urology, Milan, Italy 
o The Chinese University of Hong Kong, Department of Surgery, Hong Kong, China 
p King Abdullah International Medical Research Center, Department of Surgery, Riyadh, Saudi Arabia 
q AkfaMedline Hospital, Department of Urology, Tashkent, Uzbekistan 
r Muljibhai Patel Urological Hospital, Department of Urology, Nadiad, Gujarat, India 
s University of British Columbia, Department of Urology, Vancouver, Canada 
t Sorbonne University GRC Urolithiasis Tenon Hospital, Department of Urology, Paris, France 
u Ng Teng Fong General Hospital, Department of Urology, Singapore, Singapore 

⁎Address correspondence to: Chu Ann Chai, M.D., University Malaya, Department of Surgery, Urology Unit, 50603 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.University Malaya, Department of Surgery, Urology UnitKuala LumpurWilayah Persekutuan Kuala Lumpur50603Malaysia

Résumé

OBJECTIVE

To compare same-sitting bilateral vs unilateral retrograde intrarenal surgery (RIRS) in elderly patients, focusing on postoperative complications and stone-free rates (SFR).

METHODS

Data from 2 multicenter databases, FLEXible ureteroscopy Outcomes Registry (FLEXOR) (unilateral RIRS) and same sitting bilateral-retrograde intrarenal surgery (SSB-RIRS) (bilateral RIRS), were analyzed, considering only patients aged 70+ with preoperative computed tomography. Patients were categorized into Group 1 (bilateral RIRS) and Group 2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed.

RESULTS

Group 1 included 146 patients, while group 2 had 495. Group 1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group 2 often underwent RIRS for incidental stones. Group 1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group 1. Group 2 had significantly higher overall stone-free rates, although there were no significant differences in ancillary procedures for residual fragments. Group 1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op hematuria not requiring transfusion.

CONCLUSION

In conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counseling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.

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Vol 186

P. 117-122 - avril 2024 Retour au numéro
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