European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Retrograde Intrarenal Surgery for the Management of Renal Stones

Zeng G 1 , Zhao Z 2 , Mazzon G 3 , Pearle M 4 , Choong S 5 , Skolarikos A 6 Show all authors , Denstedt J 7 , Seitz C 8 , Olvera Pasada D 9 , Fiori C 10 , Bosio A 11 , Papatsoris A 12 , Méndez Probst CE 13 , Perez Fentes D 14 , Ann Git K 15 , Wu Q 16 , Wiseman O 17 , Emiliani E 18 , Farahat Y 19 , Ilker Gökce M 20 , Giannakopoulos S 21 , Goumas Kartalas I 22 , Somani B 23 , Knoll T 24 , de la Rosette J 25 , Zhong J 2 , Vinicius Maroccolo M 26 , Saltirov L 27 , Chew B 28 , Wang K 29 , Lahme S 30 , Giusti G 31 , Ferretti S 32 , Yong Cho S 33 , Geavlete P 34 , Cansino R 35 , Kamphuis GM 36 , Smith D 5 , Matlaga BR 37 , Ghani KD 38 , Bernardo N 39 , Silva AD 40 , Ng ACF 41 , Yang S 42 , Gao X 43 , Traxer O 44 , Miernik A 45 , Liatsikos E 46 , Priyakant Parikh K 47 , Duvdevani M 48 , Celia A 49 , Yasui T 50 , Aquino A 51 , Alomar M 52 , Choonhaklai V 53 , Erkurt B 54 , Glass J 55 , Sriprasad S 56 , Osther PJ 57 , Keeley FX 58 , Preminger GM 59 , Cepeda Delgado M 60 , Beltran Suarez E 61 , Ye Z 62 , Sarica K 63

Affiliations 

  • 1 Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. Electronic address: [email protected]
  • 2 Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
  • 3 Department of Urology, San Bassiano Hospital, Vicenza, Italy
  • 4 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
  • 5 Institute of Urology, University College Hospital London, London, UK
  • 6 Second Department of Urology, Sismanoglio General Hospital, Athens, Greece
  • 7 Division of Urology, Western University, London, ON, Canada
  • 8 Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
  • 9 Department of Urology, Hospital Zambrano Hellion, TecSalud, San Pedro Garza García, Mexico
  • 10 Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
  • 11 Department of Urology, Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
  • 12 Department of Urology, Sismanoglio General Hospital, Athens, Greece
  • 13 Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  • 14 Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
  • 15 Department of Urology, Pantai Hospital, Penang, Malaysia
  • 16 Urology Center, National University Hospital, Singapore
  • 17 Department of Urology, Cambridge University Hospitals, Cambridge, UK
  • 18 Department of Urology, Fundació Puigvert, Barcelona, Spain
  • 19 Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
  • 20 Department of Urology, Ankara University School of Medicine, Ankara, Turkey
  • 21 Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece
  • 22 Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy
  • 23 Department of Urology, University Hospital Southampton, Southampton, UK
  • 24 Department of Urology, Mannheim University Hospital, Mannheim, Germany
  • 25 Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
  • 26 Hospital de Base of the Federal District, Brasília, Brazil
  • 27 Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
  • 28 Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
  • 29 Department of Urology, West China Hospital of Sichuan University, Chengdu, China
  • 30 Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany
  • 31 Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
  • 32 Department of Urology, Hospital and University of Parma, Parma, Italy
  • 33 Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 34 Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
  • 35 Department of Urology, La Paz University Hospital, Madrid, Spain
  • 36 Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
  • 37 Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • 38 Department of Urology, University of Michigan, Ann Arbor, MI, USA
  • 39 Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
  • 40 Department of Urology, Hospital del Salvador, Salvador, Chile
  • 41 SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
  • 42 Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
  • 43 Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
  • 44 Department of Urology, Tenon Hospital, Paris, France
  • 45 Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
  • 46 Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece
  • 47 Department of Genitourinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
  • 48 Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, Israel
  • 49 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
  • 50 Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  • 51 Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
  • 52 Department of Urology, King Khalid University Hospital & Research Centre, Riyadh, Saudi Arabia
  • 53 Departments of Urology and Surgery, Rajavithi Hospital, Bangkok, Thailand
  • 54 Department of Urology, Istanbul Medipol University, Istanbul, Turkey
  • 55 Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
  • 56 Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
  • 57 Department of Urology, Lillebaelt Hospital, Vejle, Denmark
  • 58 Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
  • 59 Department of Urology, Duke University Medical Center, Durham, NC, USA
  • 60 Department of Urology, Rio Hortega University, Valladolid, Spain
  • 61 Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, Mexico
  • 62 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 63 Department of Urology, Biruni University, Medical School, Istanbul, Turkey. Electronic address: [email protected]
Eur Urol Focus, 2022 Sep;8(5):1461-1468.
PMID: 34836838 DOI: 10.1016/j.euf.2021.10.011

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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