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Vol. 39. Issue 5.
Pages 320-326 (June 2015)
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Vol. 39. Issue 5.
Pages 320-326 (June 2015)
Surgical technique
DOI: 10.1016/j.acuroe.2015.04.009
Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis
La cirugía retrógrada intrarrenal con litotricia láser holmium-YAG en el tratamiento primario de la litiasis renal
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C. Redondo, F. Ramón de Fata
Corresponding author
frfata@hotmail.com

Corresponding author.
, H. Gimbernat, E. Meilán, G. Andrés, J.C. Angulo
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
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Abstract
Introduction

retrograde intrarenal surgery (RIRS) appears as a safe and effective technique as well as a good therapeutic alternative to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL).

Material and methods

descriptive study in 50 patients surgically treated between November 2012 and April 2013. Demographic, operative and postoperative data as well as early and late complications data were collected. The minimum follow-up of patients was one year. Surgery was performed under general anesthesia. Flexible ureteroscopy with ureteral access sheath and laser fragmentation were employed. Surgery success was defined as stone free rate in postoperative control test and at three months after surgery (simple radiography, abdominal ultrasound or CT without contrast).

Results

mean age was 51.1±15.5 years old. The highest-frequency location was the lower calyceal group (26%), single stones were described in 58% of patients whilst multiple lithiasis were found in the 42%. Regarding the stone burden in 44% of the patients was low (<2cm), and high (>3cm) in 22% of the patients. The stone clearance rate was 89.7±17.5. Average surgery time was 96.6±35.2min. Complications were reported in 4 patients (8%), all of them early ones and minor in nature.

Conclusions

RIRS is an effective and safe option whose results are comparable to ESWL and PCNL. RIRS can be considered as first-line treatment. These results are corroborated by numerous studies. To strengthen these findings, prospective studies focusing on quality of life, length of stay, complications and cost-effectiveness of different treatments are needed.

Keywords:
Retrograde intrarenal surgery
Renal lithiasis
Flexible ureteroscopy
Resumen
Introducción

La cirugía retrógrada intrarrenal (CRIR), en constante desarrollo y renovación, se presenta como una técnica eficaz y segura, y una buena alternativa terapéutica a la litotricia extracorpórea (LEOC) y la nefrolitotomía percutánea (NLP).

Material y métodos

Estudio descriptivo de 50 pacientes intervenidos entre noviembre del 2012 y abril del 2013. Se recogieron datos demográficos, operatorios y postoperatorios, así como complicaciones precoces y tardías. Los pacientes fueron seguidos durante un periodo mínimo de un año. La técnica quirúrgica empleada se realizó bajo anestesia general, empleando ureteroscopio flexible, con vaina de acceso ureteral y energía de fragmentación láser. El éxito de la cirugía se definió como la ausencia de carga litiásica (stone free rate) en la prueba de control postoperatoria y a los 3 meses de la intervención (radiografía simple, ecografía o TC abdominal sin contraste).

Resultados

La media±desviación estándar de edad fue 51,1±15,5 años. La localización más frecuente fue grupo calicial inferior (26%), un 58% fueron únicas y un 42%, múltiples. En un 44% la carga litiásica fue baja (< 2cm) y en un 22% alta (> 3cm). La media de aclaramiento litiásico en esta serie fue 89,7±17,5. El tiempo quirúrgico medio fue 96,6±35,2min. Se produjeron complicaciones en 4 pacientes (8%), todas precoces y de carácter menor.

Conclusiones

La CRIR es una opción eficaz y segura, comparable a LEOC y NLP, que puede considerarse de primera línea. Numerosas series corroboran estos resultados, pero se necesitan estudios prospectivos centrados en calidad de vida, estancia media, complicaciones y coste-efectividad de los diferentes tratamientos que permitan afianzar estas conclusiones.

Palabras clave:
Cirugía retrógrada intrarrenal
Litiasis renal
Ureteroscopia flexible

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