Comparing Same-Sitting Bilateral vs Unilateral Retrograde Intrarenal Surgery in the Elderly
Chu Ann Chai1, Bhaskar Somani2, Daniele Castellani3
1University Malaya, Department of Surgery Urology Unit, Kuala Lumpur, Malaysia.
Urology
|February 28, 2024
Summary
Bilateral retrograde intrarenal surgery (RIRS) in elderly patients showed higher complication rates than unilateral RIRS. However, careful consideration and preoperative counseling are advised for bilateral RIRS in this age group.
Area of Science:
- Urology
- Nephrology
- Geriatric Medicine
Background:
- Elderly patients present unique challenges for kidney stone treatment.
- Retrograde intrarenal surgery (RIRS) is a minimally invasive option for kidney stones.
Purpose of the Study:
- To compare outcomes of same-sitting bilateral versus unilateral RIRS in patients aged 70 and older.
- To assess postoperative complications and stone-free rates (SFR) in elderly RIRS patients.
Main Methods:
- Analysis of data from two multicenter databases: FLEXOR (unilateral RIRS) and SSB-RIRS (bilateral RIRS).
- Inclusion of patients aged 70+ with preoperative computed tomography.
- Categorization into Group 1 (bilateral RIRS, n=146) and Group 2 (unilateral RIRS, n=495).
Main Results:
- Bilateral RIRS (Group 1) involved older patients with recurrent and larger pelvic stones, requiring longer operative times.
- Unilateral RIRS (Group 2) had significantly higher stone-free rates.
- Group 1 experienced more pelvicalyceal injuries, postoperative fever, and hematuria compared to Group 2.
Conclusions:
- Bilateral RIRS can be considered in elderly patients, but requires careful patient selection and counseling.
- Further research is needed to optimize surgical and laser strategies for elderly RIRS patients.
- Preoperative counseling is crucial for both primary and repeat RIRS procedures in this demographic.
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