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Objectives <p>To compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in the management of renal stones in patients with congenital renal anomalies.</p> Methods <p>In this matched-group comparative study, we prospectively enrolled patients with congenital renal anomalies and renal stones ≤ 20&#xa0;mm who underwent RIRS. These patients were matched 1:1 with those who underwent SWL at our institution. The primary outcome was the stone-free rate (SFR). Secondary outcomes included operative time, fluoroscopy time, complication rates, hospital stay, and need for retreatment.</p> Results <p>A total of 166 patients were included (83 in each group). Baseline demographic, clinical, and stone characteristics were comparable between the two groups, except that patients in the RIRS group had significantly higher BMI and stone radiodensity. The distribution of anomalies was as follows: malrotation (79.5%), horseshoe kidney (6.0%), pelvic kidney (10.8%), duplex system (2.4%), and crossed renal ectopia (1.2%). RIRS achieved a significantly higher SFR than SWL (81.9% vs. 56.6%, <i>p</i> &lt; 0.001). Complication rates were comparable between the groups (RIRS: 24.1%, SWL: 20.5%), with the majority being minor (Clavien–Dindo grade I–II). RIRS was associated with a longer operative time, shorter fluoroscopy exposure, and significantly lower retreatment rates (19.3% vs. 85.5%, <i>p</i> &lt; 0.001). The median hospital stay was 2 days for RIRS, while SWL was performed on an outpatient basis.</p> Conclusion <p>In patients with congenital renal anomalies, RIRS provides superior stone clearance and significantly reduces the need for retreatment compared to SWL, while maintaining a comparable safety profile.</p> Trial registration <p>The trial was registered at ClinicalTrials.gov (NCT05240170) (04/02/2022).</p>

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Retrograde intrarenal surgery for treatment of stones in congenital anomalous kidneys: a case-matched comparative study with extracorporeal shockwave lithotripsy

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  • 发表日期：

    2025年10月6日

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  • Abul-fotouh Ahmed,
  • Mahmoud ElMesery,
  • Mohamed Algammal,
  • Abdullah Daoud,
  • Ahmed Solyman,
  • Ahmed Mosaad

摘要

Objectives

To compare the efficacy and safety of extracorporeal shockwave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in the management of renal stones in patients with congenital renal anomalies.

Methods

In this matched-group comparative study, we prospectively enrolled patients with congenital renal anomalies and renal stones ≤ 20 mm who underwent RIRS. These patients were matched 1:1 with those who underwent SWL at our institution. The primary outcome was the stone-free rate (SFR). Secondary outcomes included operative time, fluoroscopy time, complication rates, hospital stay, and need for retreatment.

Results

A total of 166 patients were included (83 in each group). Baseline demographic, clinical, and stone characteristics were comparable between the two groups, except that patients in the RIRS group had significantly higher BMI and stone radiodensity. The distribution of anomalies was as follows: malrotation (79.5%), horseshoe kidney (6.0%), pelvic kidney (10.8%), duplex system (2.4%), and crossed renal ectopia (1.2%). RIRS achieved a significantly higher SFR than SWL (81.9% vs. 56.6%, p < 0.001). Complication rates were comparable between the groups (RIRS: 24.1%, SWL: 20.5%), with the majority being minor (Clavien–Dindo grade I–II). RIRS was associated with a longer operative time, shorter fluoroscopy exposure, and significantly lower retreatment rates (19.3% vs. 85.5%, p < 0.001). The median hospital stay was 2 days for RIRS, while SWL was performed on an outpatient basis.

Conclusion

In patients with congenital renal anomalies, RIRS provides superior stone clearance and significantly reduces the need for retreatment compared to SWL, while maintaining a comparable safety profile.

Trial registration

The trial was registered at ClinicalTrials.gov (NCT05240170) (04/02/2022).