Retrograde intrarenal surgery as a tool for lithiasis management in renal anomalies. Four cases description.

Objective: The management of stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy.

Material And Methods: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystickidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age andgender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification.

Results: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hour safter surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II).

Conclusion: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decision making.