PHÂN TÍCH CÁC YẾU TỐ ẢNH HƯỞNG ĐẾN TỶ LỆ SẠCH SỎI VÀ BIẾN CHỨNG SAU NỘI SOI NGƯỢC DÒNG TÁN SỎI THẬN BẰNG MÁY SOI MỀM TẠI BỆNH VIỆN BÌNH DÂN

Abstract

Objective: Retrograde intrarenal surgery (RIRS) using a flexible ureteroscope is an appropriate treatment for renal stones smaller than 2 cm. The stone-free rate after RIRS is relatively high, while the complication rate is low. However, the effectiveness of this method can be influenced by several factors such as stone size, stone location, urinary tract anatomy, and surgeon experience. This study aimed to evaluate the factors affecting the outcomes of RIRS at Binh Dan Hospital.

Materials and Methods: All patients diagnosed with kidney stones who underwent RIRS with a flexible ureteroscope at Binh Dan Hospital from January 2023 to November 2025 were included. This was a retrospective descriptive case-series study. Univariate logistic regression analysis was performed to identify independent predictive factors for the dependent variables.

Results: A total of 453 patients with renal stones underwent retrograde intrarenal surgery using flexible ureteroscopy. Males accounted for 53.4% of cases, and the mean age was 50.3 years. The mean stone size was 15.4 mm, and lower calyceal stones accounted for 31.3%. The mean operative time was 69.3 minutes, and the average hospital stay was 3 days. The immediate stone-free rate was 41.5%, while the stone-free rate after one month was 49.4%. The overall complication rate was 14.1%. Increasing age was associated with a lower stone-free rate after one month, with statistical significance (p = 0.001). Operative time longer than 90 minutes increased the risk of residual stones by 2.03 times, which was statistically significant (p = 0.002). Stone size showed no statistically significant association with the stone-free rate. Hypertension, elevated baseline white blood cell count, and increased urinary leukocytes were associated with a higher risk of postoperative complications (p < 0.05).

Conclusions: Retrograde intrarenal surgery using a flexible ureteroscope is a safe surgical method with a low complication rate. Age and operative time are associated with the stone-free rate. Older age is associated with a decreased likelihood of achieving stone-free status at one month, while an operative time exceeding 90 minutes is associated with a 2.03-fold increased risk of residual stones. Hypertension, elevated baseline white blood cell count, and increased urinary leukocytes increase the risk of postoperative complications.