Abstract
Objective: To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) using flexible
ureterorenoscopy (F-URS) and laser lithotripsy as a treatment option for multiple renal stones greater
than 1 cm.
Patients and methods: Between June 2015 and February 2017, 42 patients who were treated with RIRS via
F-URS and laser lithotripsy were evaluated. Stones were divided into two categories according to stone
burden, 11–20 mm and 21–30 mm. Patient’s demographics, stones characteristics, operative outcomes and
complications were evaluated prospectively. Stone free rate (SFR) was determined 4 weeks postoperatively
using findings on non-contrast computed tomography (NCCT).
Results: Mean stones burden was 25.7 mm (range from 1.3 to 30 mm), 8 patients had 11–20 mm stones
burden with SFR 100% and 34 had 21–30 mm stone burden with SFR 91.2%. The overall SFR was 92.8%.
Multiple stones were two in 31 patients (73.8%), three in 9 (21.4%) and four in 2 (4.8%). Regarding stone
number per kidney and SFR, SFR was 100%, 77.7% and 50% for kidneys with two, three and four stones
respectively. In terms of stone location in the pelvi-calyceal system and corresponding SFR, there were
renal pelvic stones in 6 (14.3%) patients with 100% SFR, upper calyx and or mid calyx and or renal pelvis
in 12 (28.6%) with SFR 91.6% and lower calyx with or without other locations in 24 with SFR 91.6%
also. Complications were minor and included, UTI in 3 patients (7.1%), hematuria of 4 days duration in 2
(4.8%), severe DJ stent irritative symptoms in one (2.4%) and minor ureteral perforations in one (2.4%).
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