Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard?

Guido Giusti, Silvia Proietti, Lorenzo G. Luciani, Roberto Peschechera, Antonella Giannantoni, Gianluigi Taverna, Giuseppe Sortino, Pierpaolo Graziotti

Research output: Contribution to journalArticlepeer-review


Introduction: Major kidney stones have traditionally been treated with percutaneous nephrolithotomy. However, retrograde intrarenal surgery (RIRS), which until a few years ago was considered inappropriate for this purpose, is becoming a viable, attractive alternative. The aim of the current study was to assess the efficacy and safety of RIRS combined with holmium laser lithotripsy for the treatment of stones > 2 cm in diameter in a large series of patients, reporting complications according to the Clavien-Dindo classification. Materials and methods: By retrospective analysis, we identified a total of 162 patients who were affected by stones greater than 2 cm in diameter and who had undergone RIRS. We reviewed demographic and stone characteristics, intraoperative and postoperative outcomes, and complications. Results: The mean stone size was 2.7 cm ± 0.6 cm. The primary, secondary, and tertiary stone-free rates were 66%, 80.9%, and 87.7%, respectively. The mean number of procedures per patient was 1.48. The complication rates according to the Clavien-Dindo classification were Clavien I in 20.4% of patients, Clavien II in 0%, Clavien III in 4.9%, Clavien IV in 0.6%, and Clavien V in 0%. Conclusions: As an alternative to standard procedures for the treatment of renal calculi greater than 2 cm in diameter, RIRS is safe and effective, with a low complication rate.

Original languageEnglish
Pages (from-to)7207-7212
Number of pages6
JournalThe Canadian journal of urology
Issue number2
Publication statusPublished - 2014


  • Complications
  • Endourology
  • Flexible ureteroscopy
  • Renal stones

ASJC Scopus subject areas

  • Urology
  • Medicine(all)


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