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    European association of urology section of urolithiasis and international alliance of urolithiasis joint consensus on retrograde intrarenal surgery for the management of renal stones
    (Elsevier B.V., 2022) Zeng, Guohua; Zhao, Zhijian; Mazzon, Giorgio; Pearle, Margaret; Choong, Simon; Skolarikos, Andreas; Denstedt, John; Seitz, Christian; Olvera Pasada, Daniel; Fiori, Cristian; Bosio, Andrea; Papatsoris, Athanasios; Méndez Probst, Carlos Enrique; Perez Fentes, Daniel; Ann Git, Kah; Wu, Qinghui; Wiseman, Oliver; Emiliani, Esteban; Farahat, Yasser; Gökçe, Mehmet İlker; Giannakopoulos, Stilianos; Goumas Kartalas, Ioannis; Somani, Bhaskar; Knoll, Thomas; de la Rosette, Jean J. M. C. H.; Zhong, Jiehui; Vinicius Maroccolo, Marcus; Saltirov, lliya; Chew, Ben; Wang, Kunjie; Lahme, Sven; Giusti, Guido; Ferretti, Stefania; Yong Cho, Sung; Geavlete, Petrisor; Cansino, Ramon; Kamphuis, Guido M.; Smith, Daron; Matlaga, Brian R.; Ghani, Khurshid D.; Bernardo, Norberto; Silva, Andres D.; Ng, Anthony C.F.; Yang, Sixing; Gao, Xiaofeng; Traxer, Olivier; Miernik, Arkadiusz; Liatsikos, Evangelos; Priyakant Parikh, Kandarp; Duvdevani, Mordechai; Celia, Antonio; Yasui, Takahiro; Aquino, Albert; Alomar, Mohammad; Choonhaklai, Vorapot; Erkurt, Bulent; Glass, Jonathan; Sriprasad, Seshadri; Osther, Palle J.; Keeley, Francis X.; Preminger, Glenn M.; Cepeda Delgado, Marcos; Beltran Suarez, Edgar; Ye, Zhangqun; Sarica, Kemal
    Background: Retrograde intrarenal surgery (RIRS) has become the preferred treatment modality for nephrolithiasis. However, because of ongoing uncertainties regarding the optimal perioperative management, operative technique, and postoperative follow-up, as well as a lack of standardization for outcome reporting, consensus is needed to achieve more uniform clinical practice worldwide. Objective: To develop recommendations for RIRS on the basis of existing data and expert consensus. Design, setting, and participants: A protocol-driven, three-phase study was conducted by the European Association of Urology Section of Urolithiasis (EULIS) and the International Alliance of Urolithiasis (IAU). The process included: (1) a nonsystematic review of the literature to define domains for discussion; (2) a two-round modified Delphi survey involving experts in this field; and (3) an additional group meeting and third-round survey involving 64 senior representative members to formulate the final conclusions. Outcome measurements and statistical analysis: The results from each previous round were returned to the participants for re-evaluation of their decisions during the next round. The agreement threshold was set at 70%. Results and limitations: The panel included 209 participants who developed 29 consensus statements on the following topics of interest: (1) perioperative infection management; (2) perioperative antithrombotic therapy; (3) fundamentals of the operative technique; and (4) standardized outcome reporting. Although this consensus can be considered as a useful reference for more clinically oriented daily practice, we also acknowledge that a higher level of evidence from further clinical trials is needed. Conclusions: The consensus statements aim to guide and standardize clinical practice and research on RIRS and to recommend standardized outcome reporting. Patient summary: An international consensus on the best practice for minimally invasive surgery for kidney stones was organized and developed by two international societies. It is anticipated that this consensus will provide further guidance to urologists and may help to improve clinical outcomes for patients.
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    Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery for the treatment of 1-2 cm lower-pole renal calculi: An international multicentre randomised controlled trial
    (Wiley, 2018) Zeng, Guohua; Zhang, Tao; Agrawal, Madhu; He, Xiang; Zhang, Wei; Xiao, Kefeng; Li, Hulin; Li, Xuedong; Xu, Changbao; Yang, Sixing; de la Rosette, Jean J. M. C. H.; Fan, Junhong; Zhu, Wei; Sarıca, Kemal
    Objectives To compare the safety and effectiveness of super-minipercutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) for the treatment of 1-2 cm lowerpole renal calculi (LPC). Patients and Methods An international multicentre, prospective, randomised, unblinded controlled study was conducted at 10 academic medical centres in China, India, and Turkey, between August 2015 and June 2017. In all, 160 consecutive patients with 1-2 cm LPC were randomised to receive SMP or RIRS. The primary endpoint was stone-free rate (SFR). Stone-free status was defined as no residual fragments of >= 0.3 cm on plain abdominal radiograph of the kidneys, ureters and bladder, and ultrasonography at 1-day and on computed tomography at 3-months after operation. Secondary endpoints included blood loss, operating time, postoperative pain scores, auxiliary procedures, complications, and hospital stay. Postoperative follow-up was scheduled at 3 months. Analysis was by intention-totreat. The trial was registered at http://clinicaltrials. gov/ (NCT02519634). Results The two groups had similar baseline characteristics. The mean (SD) stone diameters were comparable between the groups, at 1.50 (0.29) cm for the SMP group vs 1.43 (0.34) cm for the RIRS group (P = 0.214). SMP achieved a significantly better 1-day and 3-month SFR than RIRS (1-day SFR 91.2% vs 71.2%, P = 0.001; 3-months SFR 93.8% vs 82.5%, P = 0.028). The auxiliary procedure rate was lower in the SMP group. RIRS was found to be superior with lower haemoglobin drop and less postoperative pain. Blood transfusion was not required in either group. There was no significant difference in operating time, hospital stay, and complication rates, between the groups. Conclusions SMP was more effective than RIRS for treating 1-2 cm LPC in terms of a better SFR and lesser auxiliary procedure rate. The complications and hospital stay were comparable. RIRS has the advantage of less postoperative pain.