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EAU 2019

EAU 2019: When is the Best Time to Assess the Stone Free Rate After Laser Lithotripsy?

Barcelona, Spain (UroToday.com) Stone Free rate remains the primary outcome in the management of urolithiasis. Yet, methods of estimation remain disputable due to differences in the timing of the assessment and the size and location of residual stone fragments. Wide acceptance of stone-free rate estimation on the first postoperative day (POD) may not be optimal since dust accumulations can mimic real residual fragments at short-term follow-ups. The aim of the study performed by Dr. Alim Dymov and colleagues was to evaluate and compare the effectiveness of stone-free rate assessment at first and ninetieth postoperative days.

The study included a total of 32 patients who underwent RIRS for renal stones with a median stone size of 11,4 mm and mean stone density of 987 HU. For lithotripsy, SuperPulse Thulium fiber laser (IRE Polus, Russia) was used. Stone free rate on the first POD was achieved only in 7% of cases. Whereas remaining patients (93%) had residuals of less than 3 mm in 39%, 4 – 6 mm in 22%,  7 - 9 mm in 22%, more than 10 mm in 17%. On the POD 90 authors observed a dramatic change in stone-free rate with 91% of without residuals. In the 9 % of cases with residuals, the stone size was less than 2 mm in 75% and 3 mm in 25%.

This leads the authors to the conclusion that the stone-free rate on POD 1 after RIRS is likely to be due to dust accumulations in the collecting system of the kidney. And that complete wash-out of stone fragments requires longer time. Small size cohort decreases study impact however further development in this field obviously allow to unify ideal SFR assessment time.


Presented by: Alim Dymov, MD, Ph.D., First Sechenov Moscow State Medical University, Urologist, Moskva, Russia 

Written by: Mark Taratkin, MD, Researcher, Institute for Urology and Reproductive Health, Sechenov University at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.