This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS) following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) and stone disease.
Materials and Methods
Patients with concomitant UPJO and renal stone disease who were first treated in our clinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to 2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matched with those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results were compared in order to evaluate the effects of rLEP surgery on RIRS.
Subsequently, patients who underwent RIRS following rLEP were independently evaluated and factors affecting the success of sequential procedures were investigated.
The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normal anatomy that underwent RIRS was in operative times (p=.011). Evaluation of potential success factors in the sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stone size and presence of single stone showed significant effects (p=.047, p=.030, p=.040, p? .001, respectively).
RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1% obstruction-free rate.
RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It can be used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.
Rutchik SD, Resnick MI. Ureteropelvic junction obstruction and renal calculi. Pathophysiology and implications for management. Urol Clin North Am. 1998;25:317-21.
Bachmann A, Ruszat R, Forster T, et al. Retroperitoneoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO): solving the technical difficulties. Eur Urol. 2006;49:264-72.
Bernardo NO, Liatsikos EN, Dinlenc CZ, Kapoor R, Fogarty JD, Smith AD. Stone recurrence after endopyelotomy. Urology. 2000;56:378-81.
Husmann DA, Milliner DS, Segura JW. Ureteropelvic junction obstruction with a simultaneous renal calculus: long-term followup. J Urol. 1995;153:1399-402.
Matin SF, Streem SB. Metabolic risk factors in patients with ureteropelvic junction obstruction and renal calculi. J Urol. 2000;163:1676-8.
Skolarikos A, Dellis A, Knoll T. Ureteropelvic obstruction and renal stones: etiology and treatment. Urolithiasis. 2015;43:5-12.
Geavlete P, Georgescu D, Mirciulescu V, Nita G. Ureteroscopic laser approach in recurrent ureteropelvic junction stenosis. Eur Urol. 2007;51:1542-8.
Inagaki T, Rha KH, Ong AM, Kavoussi LR, Jarrett TW. Laparoscopic pyeloplasty: current status. BJU Int. 2005;95 Suppl 2:102-5.
Stein RJ, Turna B, Nguyen MM, et al. Laparoscopic pyeloplasty with concomitant pyelolithotomy: technique and outcomes. J Endourol. 2008;22:1251-5.
Stravodimos KG, Giannakopoulos S, Tyritzis SI, et al. Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature. Res Rep Urol. 2014;6:43-50.
Ramakumar S, Lancini V, Chan DY, Parsons JK, Kavoussi LR, Jarrett TW. Laparoscopic pyeloplasty with concomitant pyelolithotomy. J Urol. 2002;167:1378-80.
Srivastava A, Singh P, Gupta M, et al. Laparoscopic pyeloplasty with concomitant pyelolithotomy--is it an effective mode of treatment? Urol Int. 2008;80:306-9.
Mufarrij PW, Woods M, Shah OD, et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience. J Urol. 2008;180:1391-6.
Nayyar R, Gupta NP, Hemal AK. Robotic management of complicated ureteropelvic junction obstruction. World J Urol. 2010;28:599-602.
Berkman DS, Landman J, Gupta M. Treatment outcomes after endopyelotomy performed with or without simultaneous nephrolithotomy: 10-year experience. J Endourol. 2009;23:1409-13.
Agarwal A, Varshney A, Bansal BS. Concomitant percutaneous nephrolithotomy and transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction complicated by stones. J Endourol. 2008;22:2251-5.
Gupta M, Tuncay OL, Smith AD. Open surgical exploration after failed endopyelotomy: a 12-year perspective. J Urol. 1997;157:1613-8; discussion 8-9.
Lucas JW, Ghiraldi E, Ellis J, Friedlander JI. Endoscopic Management of Ureteral Strictures: an Update. Curr Urol Rep. 2018;19:24.
Van Cleynenbreugel B, Kilic O, Akand M. Retrograde intrarenal surgery for renal stones - Part 1. Turk J Urol. 2017;43:112-21.
Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score". Urology. 2012;80:512-8.
Ludwig WW, Matlaga BR. Urinary Stone Disease: Diagnosis, Medical Therapy, and Surgical Management. Med Clin North Am. 2018;102:265-77.
Khan F, Ahmed K, Lee N, Challacombe B, Khan MS, Dasgupta P. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol. 2014;11:629-38.
Guzel O, Tuncel A, Balci M, et al. Retrograde Intrarenal Surgery is equally efficient and safe in patients with different American Society of Anesthesia physical status. Ren Fail. 2016;38:503-7.
Turk C, Petrik A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69:475-82.
De S, Autorino R, Kim FJ, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015;67:125-37.
Berardinelli F, Cindolo L, De Francesco P, et al. The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones: a propensity score analysis. Urolithiasis. 2017;45:387-92.