[Management of complex renal stones by a novel ureterorenoscope with vacuum suctioning system combined with flexible ureteroscope].

ABSTRACT

Objective: To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones. Methods: Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients' information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared. Results: A total of 347 patients were included in the study, with 220 males and 127 females. The age [M(Q1,Q3)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [M(Q1,Q3)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (P=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, P<0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5), P=0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, P=0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, P<0.001), while the difference in complication rate was not statistically significant (P>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm, P<0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm, P=0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, P<0.001) and lower complication rate(10.7% vs 31.6%, P=0.012) compared to those with stone size >40 mm. Conclusion: Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.