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1040 Impact of preoperative D-J stenting on success and complications of RIRS
1040
Impact of preoperative D-J stenting on success and complications of RIRS Eur Urol Suppl 2016;15(3);e1040
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Şahin T.1 , Senocak C.1 , Ozcan C.1 , Oguz U.2 , Ozyuvali E. 3 , Yordam M. 1 , Damar E. 1 , Bozkurt O.F. 1 1 Kecioren
Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 2 Giresun University,Faculty of Medicine, Dept. of Urology,
Giresun, Turkey, 3 Turgut Ozal University, Faculty of Medicine, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: A randomized, controlled and prospective study was planned to investigate the impact of preoperative D-J stenting on success and complications of RIRS. MATERIAL & METHODS: We randomized total 110 patients into two groups. At the group I, RIRS was performed after preoperative D-J stenting. At the group II, RIRS was performed without prestenting. Initial success was evaluated with KUB and USG on the first day of surgery and final success was evaluated with CT on the first month of surgery. Stone-free defined as clinically insignificant residual stones less than 4 mm on imaging. Complications were classified intraoperatively with modified Satava classification system and postoperatively with modified Clavien classification system. Ureteral injuries after RIRS were assessed visually and classified with “Ureteral Wall Injury Endoscopic Classification”. RESULTS: Initial success (postop. 1. day) was found significantly higher in group I than group II (85,5% vs. 67,3%, p<0,05) Final success (postop. 1. month) was revealed at 51 patients (92,7%) in group I and was revealed at 39 patients (75%) in group II(p<0,05). Intraoperative complications to the modified Satava classification system were recorded significantly less in group I than in group II (9,1% vs. 50,9%, p<0,0001). To the modified Clavien classification system postoperative complications were shown higher in group II (25,5%) but it was not statistically significant (p=0,233). Ureteral injury was observed significantly higher non-pre-stenting patients than pre-stenting patients (32,73% vs. 3,64%, p<0,0001). Pre-stenting before RIRS decreased the risk of ureteral injury by ninefold. VAS results were significantly higher non-pre-stenting patients than pre-stenting patients (p<0,0001).
Residue absent Initial Success (Postop. 1’st day) Residue present Total Residue absent Final Success (Postop. 1’st month) Residue present Total Absent Modified Satava Present Total Absent Modified Clavien Present Total
Groups DJ + n % 47 85,5 8 14,5 55 100,0 51 92,7 4 7,3 55 100,0 50 90,9 5 9,1 55 100,0 47 85,5 8 14,5 55 100,0
DJ n % 37 67,3 18 32,7 55 100,0 39 75,0 13 25,0 52 100,0 27 49,1 28 50,9 55 100,0 41 74,5 14 25,5 55 100,0
Total n % 84 76,4 26 23,6 110 100,0 90 84,1 17 15,9 107 100,0 77 70,0 33 30,0 110 100,0 88 80,0 22 20,0 110 100,0
Parameters
Group I (D-J +)
Group II (D-J -)
p
p
0,043
0,025
0,0001
0,233
Age Sex Male Female Stone Location Prox. Ureter Pelvis Upper/mid. Calix Lower Calix Multiple Stone Size (mm) (Ave.±SD(min-max)) Postoperative D-J Stent Yes No VAS Score Analgesic usage ≤2 doses >2 doses Total dose Ureteral injury No Yes
45.44±15.43(10-79) 47.96±14.81(13-76) 0.294 34(61.8%) 24(43.6%) 0.086 21(38.2%) 31(56.4%) 10(18.1%) 11(20.0%) 18(32.8%) 20(36.3%) 6(10.9%) 7(12.7%) 0.591 16(29.1%) 12(21.8%) 5(9.1%) 4(7.2%) 13.95±6.48(5-35) 12.95±4.58(6-25) 0.850 16(29,1%) 18(32,73%) 0,313 39(70,9%) 37(67,27%) 4,45±1,49(1-9) 5,92±1,37(3-9) <0,001 50(90,9%) 41(80,4%) 5(9,1%) 10(19,6%) 0,202 73 95 0,001 53(96,36%) 37(67,27%) <0,001 2(3,64%) 18(32,73%)
CONCLUSIONS: Preoperative D-J stenting significantly increases the success of RIRS while decreases the complications of RIRS. Also ureteral pre-stenting decreases postoperative pain scores and analgesic requirement.
Impact of preoperative D-J stenting on success and complications of RIRS Eur Urol Suppl 2016;15(3);e1040
Print! Print!
Şahin T.1 , Senocak C.1 , Ozcan C.1 , Oguz U.2 , Ozyuvali E. 3 , Yordam M. 1 , Damar E. 1 , Bozkurt O.F. 1 1 Kecioren
Training and Research Hospital, Dept. of Urology, Ankara, Turkey, 2 Giresun University,Faculty of Medicine, Dept. of Urology,
Giresun, Turkey, 3 Turgut Ozal University, Faculty of Medicine, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: A randomized, controlled and prospective study was planned to investigate the impact of preoperative D-J stenting on success and complications of RIRS. MATERIAL & METHODS: We randomized total 110 patients into two groups. At the group I, RIRS was performed after preoperative D-J stenting. At the group II, RIRS was performed without prestenting. Initial success was evaluated with KUB and USG on the first day of surgery and final success was evaluated with CT on the first month of surgery. Stone-free defined as clinically insignificant residual stones less than 4 mm on imaging. Complications were classified intraoperatively with modified Satava classification system and postoperatively with modified Clavien classification system. Ureteral injuries after RIRS were assessed visually and classified with “Ureteral Wall Injury Endoscopic Classification”. RESULTS: Initial success (postop. 1. day) was found significantly higher in group I than group II (85,5% vs. 67,3%, p<0,05) Final success (postop. 1. month) was revealed at 51 patients (92,7%) in group I and was revealed at 39 patients (75%) in group II(p<0,05). Intraoperative complications to the modified Satava classification system were recorded significantly less in group I than in group II (9,1% vs. 50,9%, p<0,0001). To the modified Clavien classification system postoperative complications were shown higher in group II (25,5%) but it was not statistically significant (p=0,233). Ureteral injury was observed significantly higher non-pre-stenting patients than pre-stenting patients (32,73% vs. 3,64%, p<0,0001). Pre-stenting before RIRS decreased the risk of ureteral injury by ninefold. VAS results were significantly higher non-pre-stenting patients than pre-stenting patients (p<0,0001).
Residue absent Initial Success (Postop. 1’st day) Residue present Total Residue absent Final Success (Postop. 1’st month) Residue present Total Absent Modified Satava Present Total Absent Modified Clavien Present Total
Groups DJ + n % 47 85,5 8 14,5 55 100,0 51 92,7 4 7,3 55 100,0 50 90,9 5 9,1 55 100,0 47 85,5 8 14,5 55 100,0
DJ n % 37 67,3 18 32,7 55 100,0 39 75,0 13 25,0 52 100,0 27 49,1 28 50,9 55 100,0 41 74,5 14 25,5 55 100,0
Total n % 84 76,4 26 23,6 110 100,0 90 84,1 17 15,9 107 100,0 77 70,0 33 30,0 110 100,0 88 80,0 22 20,0 110 100,0
Parameters
Group I (D-J +)
Group II (D-J -)
p
p
0,043
0,025
0,0001
0,233
Age Sex Male Female Stone Location Prox. Ureter Pelvis Upper/mid. Calix Lower Calix Multiple Stone Size (mm) (Ave.±SD(min-max)) Postoperative D-J Stent Yes No VAS Score Analgesic usage ≤2 doses >2 doses Total dose Ureteral injury No Yes
45.44±15.43(10-79) 47.96±14.81(13-76) 0.294 34(61.8%) 24(43.6%) 0.086 21(38.2%) 31(56.4%) 10(18.1%) 11(20.0%) 18(32.8%) 20(36.3%) 6(10.9%) 7(12.7%) 0.591 16(29.1%) 12(21.8%) 5(9.1%) 4(7.2%) 13.95±6.48(5-35) 12.95±4.58(6-25) 0.850 16(29,1%) 18(32,73%) 0,313 39(70,9%) 37(67,27%) 4,45±1,49(1-9) 5,92±1,37(3-9) <0,001 50(90,9%) 41(80,4%) 5(9,1%) 10(19,6%) 0,202 73 95 0,001 53(96,36%) 37(67,27%) <0,001 2(3,64%) 18(32,73%)
CONCLUSIONS: Preoperative D-J stenting significantly increases the success of RIRS while decreases the complications of RIRS. Also ureteral pre-stenting decreases postoperative pain scores and analgesic requirement.