[Retrograde intrarenal surgery (RIRS). Technical complement for cases of acute XXXX ].

@entity1 @entity8 @entity5648 @entity1290 @entity9279
INTRODUCTION: Washing the renal cavities using minipercutaneous surgery shaft is an ideal technical procedure for retrograde intrarenal surgery (RIRS) when lithiasic fragmentation is significant or if the anatomy of the renal cavities may obstruct the spontaneous elimination of fragments. MATERIALS AND METHODS: we performed 37 RIRS on 35 @entity1 with @entity8 (14 @entity1 , 21 @entity1 ) with a mean age of 56 (range 33-72) years, divided into two groups in accordance with the size of their @entity1290 . Group A, 23 @entity1 with @entity9279 <1.5 cm; Group B, 12 cases with @entity9279 >1.5 cm. 28 @entity1 had a single kidney stone and 7 had multiple stones. APPROACH: Flexible uretrorenoscopy, 7.5 Fr (Flex-X(  , Karl Storz) by means of a ureteral access sheath. Holmium laser lithotripsy (Calculase  , Karl Storz) using 200 and 365 micrometer fibres. Fragment extraction with 1.7 Fr @entity5648 baskets (N-gage, Cook). In cases of significant fragmented stone burden, the renal cavities were washed with low-pressure fluid irrigation using a ureteral access sheath, which was collected together with the stone fragments carried by the "mini-perc" sheath (Ultrax-x   18Fr, Cook; Rusch, 14 Fr) placed under radiologic and endoscopic control at the level of the calyx-papilla selected for fragment drainage. RESULTS: the mean diameter for group A was 9.13 (range 5-13) mm and 20.25 (range 16-28) mm for group B. The overall mean operating time was 81 (range 30-160) min. Group A required 66.43  35.18 min. and group B 107.5  46.73 min. (p=0.006). The rate of absence of stones immediately after surgery was 83.2%, 93.1% at 3 months (95.6% for A and 83.3% for B; p=0.217). In no case was ureteral stenosis observed as a result of the use of ureteral access sheaths. In 7 group B @entity1 (58.3%) with acute @entity9279 and/or alteration in their pyelocaliceal anatomy, we performed active lavage of the renal cavities applying the aforementioned percutaneous technique. The mean post-surgery hospital stay was 2.1 (range 1-4) days. There were post-surgery complications (Clavien 1) in 7 @entity1 (20%). Two @entity1 required a second FURS. CONCLUSIONS: RIRS can be effective treatment for @entity8 >1.5 cm. Lavage of the renal cavities helps to eliminate stone fragments, reducing the possibility of retreatment.
