Presented by: Rifat Burak Ergül
Department of Urology, Istanbul University Istanbul Faculty of Medicine

Introduction

With the recent technological advances in endourology, retrograde intrarenal surgery (RIRS) has become a more popular procedure for the treatment of kidney stone. In addition, since the introduction of new laser systems and advanced flexible ureteroscopy with miniature ureteroscopes, retrograde intrarenal surgery has become feasible for more complex kidney stones.

Image quality in RIRS is an important parameter that affects the success of the operation and postoperative complications. Perioperative bleeding is an important complication that degrades the image during the operation. It is thought that the underlying reason for the increase in the amount of bleeding, especially in urological surgeries, is the fibrinolytic effect of high plasminogen concentration in the urine. It is predicted that even minimal bleeding during RIRS will affect the image quality of the operation, thus prolonging the operation time, reducing the success of the operation, and even increasing the complication.  In our study, we aimed to investigate the safety and effectiveness of tranexamic acid used in RIRS in patients with challenging stone cases.

Materials

Data of 42 patients who underwent RIRS for complex kidney stones between November 2020 and April 2023 were analyzed. In the study, we used the ITO score from RIRS nomograms to identify complex cases. We defined complex cases as ITO scores of 15 and below. Group 1 included 21 patients who were administered tranexamic acid and group 2 included 21 patients who were not administered tranexamic acid. At the beginning of anesthesia induction, 500 mg of tranexamic acid diluted in 100 ml of saline was infused intravenously over 10 minutes. Preoperative demographic data of the patients, stone features, and postoperative outcomes were noted. In addition, the modified Clavien–Dindo classification system (MCDCS) was used to evaluate the postoperative complications of RIRS. Continuous data were compared with the Mann-Whitney U test, and categorical data were compared with the chi-square test.

Results

,

The mean age of group 1 was 40 ±14 (23-74), while group 2 was 46.6±15 (20-73). the male/female ratio was 11/10 and 15/6 in Group 1 and Group 2, respectively. There was no significant difference between the groups in terms of demographic data and stone characteristics. Fluoroscopy, f-URS, and stone disintegration times were statistically significantly lower in group 1. (p<0.05) We noticed that the operation was lower in Group 1, although it was not statistically significant. While the number of complications was lower in group 2, it was not statistically significant. The stone-free rate rates were the same for both groups. Tranexamic acid-induced thromboembolic events were not observed in any of the patients.

Conclusion

With tranexamic acid, it is possible to perform an effective and safe RIRS procedure in challenging stone cases. Future studies would support the outcomes of this study.

Funding

None

Lead Authors

Yasin Yitgin, Asst. Prof. Dr.
Istinye Universtiy Faculty of Medicine, Depatment of Urology, Istanbul, Turkey

Co-Authors

Rifat Ergül, Resident
Department of Urology, Istanbul University Istanbul Faculty of Medicine

Tzevat Tefik, Asst. Prof. Dr.
Department of Urology, Istanbul University Istanbul Faculty of Medicine