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Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study.

ABSTRACT: BACKGROUND:We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study. METHODS:Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medicine tests. Maneuverability and accessibility were evaluated after every surgery. All procedures were performed by a single experienced surgeon (SY Cho). RESULTS:Stone-free rate was higher in the GA (92.3%, 36 of 39) than the SA (71.0%, 22 of 31) (P?=?0.019) group. Pain score was higher in the GA than in the SA group on the first postoperative morning (P?=?0.025), but pain scores of the two groups were similar before discharge (P?=?0.560). There were no differences in the changes of serum creatinine level (P?=?0.792) and changes of estimated glomerular filtration rate (P?=?0.807). Differences of separate renal function between operative and contralateral site increased significantly in patients under GA than under SA at postoperative 3?months (P?=?0.014). Maneuverability and accessibility were better in SA with sedation than GA (P?

SUBMITTER: Kwon O

PROVIDER: S-EPMC6927176 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study.

Kwon Ohseong O Lee Jung-Man JM Park Juhyun J Cho Min Chul MC Son Hwancheol H Jeong Hyeon H Ryang Seung Hoon SH Cho Sung Yong SY

BMC anesthesiology 20191223 1

<h4>Background</h4>We analyzed the influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal surgery (RIRS) in a prospective, randomized controlled study.<h4>Methods</h4>Seventy patients who underwent RIRS from September 2015 to February 2017 were randomly allocated to general anesthesia (GA) or spinal anesthesia (SA) groups. Renal function was assessed using estimated glomerular filtration rate, and separate renal function was evaluated using nuclear medic ...[more]

PMID: 31870417

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Project description:BackgroundRetrograde intrarenal surgery (RIRS) is widely performed for renal stones. Theoretically, removing renal stones could prevent the deterioration of renal function. However, two studies reported that not all patients would see an increase in renal function after RIRS. The aim of our study was to evaluate the change of renal function of the operative site, and to identify predictors of improvement or deterioration of renal function after RIRS.MethodsWe retrospectively reviewed renal stones patients who received RIRS and single-photon emission computed tomography (SPECT) before and after surgery. Improved renal function was defined as the change of glomerular filtration rate (GFR) >10% postoperatively, and that <-10% was regarded as deteriorated renal function. Logistic and least absolute shrinkage and selection operator regression analyses were used to identify predictors for the improvement or deterioration of renal function, and predictive nomogram models were built.ResultsA total of 120 renal stone patients were included. Twenty-one (17.5%), 79 (65.8%) and 20 (16.7%) patients had improved, stable and deteriorated renal function of operative site after surgery, respectively. Lower alkaline phosphatase, lower low-density lipoprotein, lower GFR of the operative site, thicker renal parenchyma, higher serum creatinine, and extracorporeal shock wave lithotripsy (SWL) history were associated with the improved renal function. The predictive accuracy of the model for the improved renal function was 0.800. Additionally, older age, longer flexible ureteroscopic time, thinner renal parenchyma and existence of ureteral stones were risk factors for deteriorated renal function. The predictive accuracy of the model for the deteriorated renal function was 0.725.ConclusionsThe renal function of most renal stone patients did not decrease after RIRS. For patients with potential deterioration of renal function postoperatively, urologists could shorten flexible ureteroscopic time to prevent the occurrence of this outcome.

Project description:BackgroundRetrograde intrarenal surgery (RIRS) is the main treatments for upper urinary tract stones. The Ureteral Access Sheath (UAS) serves as a supplementary tool, facilitating direct kidney access during RIRS. High quality of evidence comparing tip bendable suction ureteral access sheath (S-UAS) with traditional UAS in RIRS for the treatment of renal and ureteral stones is lacking. The purpose of the study is to compare the efficacy and safety of S-UAS with traditional UAS in RIRS for the treatment of renal or ureteral stones ≤30 mm.MethodsAn international, multicenter, and superiority randomized controlled trial included 320 intention-to-treat patients across 8 medical centers in China, the Philippines, Malaysia and Turkey from August 2023 to February 2024. The inclusion criteria were patients ≥18 years old with renal or ureteral stones ≤30 mm. RIRS was performed using either S-UAS or traditional UAS. The primary outcome was the immediately stone-free rate (SFR). Secondary outcomes included SFR 3 months after operation, operating time, hospital stay, auxiliary procedures, complications (using the Clavien-Dindo grading system), and improvement in the Quality of Life (QoL) score. Differences between proportions [risk difference (RD)]/means [mean difference (MD)] and 95% confidence intervals (CI) were presented. This study is registered at ClinicalTrials.gov: NCT05952635.FindingsThe S-UAS group demonstrated a significantly higher immediately SFR (81.3% versus 49.4%; RD 31.9%; 95% CI 22.5%-41.7%; p = 0.004) compared to the traditional UAS group, as determined by the one-side superiority test. Additionally, the S-UAS group exhibited a higher SFR at 3 months post-operation (87.5% versus 70.0%; RD 17.5%; 95% CI 8.7%-26.3%; p < 0.001), lower postoperative fever rate (RD -11.9%; 95% CI -18.7% to -4.9%; p < 0.001), reduced use of stone baskets (RD -70.6%; 95% CI -77.8% to -63.5%; p < 0.001), and better QoL improvement (MD 7.25; 95% CI 2.21-12.29; p = 0.005). No statistically significant differences were observed in operation time, hospital stay, or the need for second-stage RIRS.InterpretationIn RIRS for upper urinary tract stones ≤30 mm, S-UAS exhibited superior performance compared to traditional UAS, demonstrating higher SFR, reduced postoperative fever rate, and improved QoL outcomes. S-UAS emerges as a prudent and advantageous alternative to traditional UAS for RIRS.FundingNational Natural Science Foundation of China and Guangdong Province, and Zhejiang Medicine and Health Program.

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Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study.

Publications

Influence of anesthesia methods on surgical outcomes and renal function in retrograde intrarenal stone surgery: a prospective, randomized controlled study.

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