Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

EndNote Style
Original Article
Comparative evaluation of retrograde intrarenal surgery using ureteral access sheath and fluoroscopy: a retrospective analysis on kidney stone treatment
Aims: This study aimed to investigate the outcomes of retrograde intrarenal surgery (RIRS) with and without the utilization of ureteral access sheath (UAS) and fluoroscopy for treating kidney stones and its implications on postoperative complications.
Methods: Employing a retrospective design, we analyzed the records of 314 patients subjected to RIRS due to kidney stones. Patients were categorized into two groups based on the application of fluoroscopy and UAS (Group 1) versus non-application (Group 2). Various metrics, including stone-free rates, residual stone rates, and postoperative complications, were compared between the groups.
Results: The results showed no significant differences between the two groups regarding patient age, stone size, and several demographic parameters. However, there was a considerable reduction in operation duration in Group 2 (20.96±5.97 minutes) compared to Group 1 (26.15±5.41 minutes), where UAS and fluoroscopy were applied, with p=0.001. Furthermore, post-treatment results highlighted a decline in residual stone rates and an enhancement in stone-free rates, though differences between groups were not significant. The incidence of postoperative complications, like fever, urinary tract infections, and ureteral stenosis, was assessed, revealing no differences between the two groups.
Conclusion: The application of RIRS without UAS and fluoroscopy appears to be a promising approach to treating kidney stones, offering similar outcomes regarding stone removal efficacy and postoperative complications compared to the traditional method with UAS and fluoroscopy. This research emphasizes the potential of a less invasive method, warranting further studies to understand its broad implications.

1. Venkatachalapathy VSS, Palathullil DG, Sam DM, Prasad A,Abraham GP. Outcomes of retrograde intrarenal surgery in renalcalculi of varying size. Indian J Urol. 2022;38(2):128-134.
2. Lim EJ, Traxer O, Madarriaga YQ, et al. Outcomes and lessonslearnt from practice of retrograde intrarenal surgery (RIRS) in apaediatric setting of various age groups: a global study across 8centres. World J Urol. 2022;40(5):1223-1229.
3. Gauhar V, Chew BH, Traxer O, et al. Indications, preferences,global practice patterns and outcomes in retrograde intrarenalsurgery (RIRS) for renal stones in adults: results from amulticenter database of 6669 patients of the global FLEXibleureteroscopy Outcomes Registry (FLEXOR). World J Urol.2023;41(2):567-574.
4. Chai CA, Teoh YC, Tailly T, et al. Influence of pre-stentingon RIRS outcomes. Inferences from patients of the GlobalMulticentre Flexible Ureteroscopy Outcome Registry (FLEXOR).Minerva Urol Nephrol. 2023;75(4):493-500.
5. Sforza S, Crisci A, Cini C, Masieri L. Commentary: outcomesand lessons learnt from practice of retrograde intrarenal surgery(RIRS) in a paediatric setting of various age groups: a global studyacross 8 centres. World J Urol. 2022;40(6):1595-1596.
6. Quhal F, Zeng G, Seitz C. Current evidence for suction inendourological procedures: comprehensive review of literature.Curr Opin Urol. 2023;33(2):77-83.
7. Xiang Y, Yan T, Fu M, Quan K, Shu J, Wang R. The regular use ofcalcium channel blockers before flexible URS appears to facilitateprimary UAS insertion: a retrospective study in a single center.Int Urol Nephrol. 2023;55(3):547-551.
8. Özman O, Çınar Ö, Çakır H, et al. Is it a good strategy to proceeda retrograde intrarenal surgery session sheathless after ureteralaccess sheath insertion failure? a RIRSearch study. J Endourol.2023;37(7):747-752.
9. Panthier F, Pauchard F, Traxer O. Retrograde intra renal surgeryand safety: pressure and temperature. a systematic review. CurrOpin Urol. 2023;33(4):308-317.
10. Weld LR, Nwoye UO, Knight RB, et al. Fluoroscopy time duringuncomplicated unilateral ureteroscopy for urolithiasis decreaseswith urology resident experience. World J Urol. 2014;33(1):119-124.
11. Greene DJ, Tenggadjaja CF, Bowman RJ, Agarwal G, EbrahimiKY, Baldwin DD. Comparison of a reduced radiation fluoroscopyprotocol to conventional fluoroscopy during uncomplicatedureteroscopy. Urology. 2011;78(2):286-290.
12. Türk C, Petrík A, Sarica K, et al. EAU Guidelines on InterventionalTreatment for Urolithiasis. Eur Urol. 2016;69(3):475-482.
13. Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, PattanittumP. Extracorporeal shock wave lithotripsy (ESWL) versuspercutaneous nephrolithotomy (PCNL) or retrograde intrarenalsurgery (RIRS) for kidney stones. Cochrane Database Syst Rev.2023;8(8):Cd007044
14. Mahmood SN, Ahmed CJ, Tawfeeq H, et al. Evaluation of mini-PCNL and RIRS for renal stones 1-2 cm in an economicallychallenged setting: a prospective cohort study. Ann Med Surg(Lond). 2022;81:104235.
15. Lima A, Reeves T, Geraghty R, Pietropaolo A, Whitehurst L,Somani BK. Impact of ureteral access sheath on renal stonetreatment: prospective comparative non-randomised outcomesover a 7-year period. World J Urol. 2020;38(5):1329-1333.
16. Damar E, Senocak C, Ozbek R, et al. Does ureteral access sheathaffect the outcomes of retrograde intrarenal surgery: a prospectivestudy. Minim Invasive Ther Allied Technol. 2022;31(5):777-781.
17. De Coninck V, Somani B, Sener ET, et al. Ureteral access sheathsand its use in the future: a comprehensive update based on aliterature review. J Clin Med. 2022;11(17): 5128.
18. Sari S, Çakici MÇ, Kartal IG, et al. Comparison of the efficiency,safety and pain scores of holmium laser devices working with20 watt and 30 watt using in retrograde intrarenal surgery:One center prospective study. Archivio Italiano di Urologia eAndrologia. 2020;92(2).
19. Bozkurt M, Seker KG. Fluoroscopy-free RIRS on the second sessionafter ureteral stent placement. Urologia. 2023;90(1):130-135.
20. Mahmood SN, Toffeq H, Fakhralddin S. Sheathless andfluoroscopy-free retrograde intrarenal surgery: An attractive wayof renal stone management in high-volume stone centers. Asian JUrol. 2020;7(3):309-317.
Volume 4, Issue 5, 2023
Page : 472-477