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Intrarenal Surgery for Kidney Stones and Other Kidney Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 20 October 2026 | Viewed by 2762

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Special Issue Editor

Dr. Razvan Multescu

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Guest Editor

Department of Urology, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania
Interests: kidney stones; urolithiasis; flexible ureteroscopy; percutaneous nephrolithotomy; metaphylaxis; laser; lithotripsy
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Special Issue Information

Dear Colleagues,

Intrarenal surgery is an evolving landscape that encompasses both established and novel approaches to the management of kidney stones and other renal pathologies. Recent advances in endourology have included novel lasers; thinner flexible ureteroscopes, most of which are single-use; miniaturized percutaneous nephrolithotomy; and novel accessory instruments such as flexible and navigable access sheaths or automated platforms that incorporate artificial intelligence to regulate irrigation and suction for enhanced visibility and safety. All of these developments have significantly enhanced surgical efficacy, reduced morbidity, and expanded the indications for minimally invasive interventions. Beyond lithiasis, intrarenal surgery is increasingly applied to the management of other pathologies such as urothelial tumors or congenital abnormalities. The integration of these new devices and techniques is transforming standards and the outcome of procedures. This Special Issue welcomes the submission of original research and clinical perspectives on operative techniques, outcome metrics, complication management, and future innovations in intrarenal surgery.

Dr. Razvan Multescu
Guest Editor

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Keywords

intrarenal surgery
flexible ureteroscopy
percutaneous nephrolithotomy (PCNL)
Mini-PCNL
thulium laser
ureteral access sheaths
flexible and navigable suction (FANS)
upper urinary tract urothelial tumors

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Published Papers (4 papers)

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Research

10 pages, 212 KB

Open AccessArticle

Selective Omission of Ureteral Access Sheath in Retrograde Intrarenal Surgery: Surgical and Safety Outcomes from a Single-Center Retrospective Cohort Study

by Po-Sung Liang, Yu-Jun Chang, Jian-Kai Chen and Hung-Jen Shih

J. Clin. Med. 2026, 15(6), 2345; https://doi.org/10.3390/jcm15062345 - 19 Mar 2026

Viewed by 381

Abstract

Introduction: The ureteral access sheath (UAS) is commonly used in retrograde intrarenal surgery (RIRS) to improve vision, lower intrarenal pressure (IRP), and facilitate access. However, concerns regarding ureteral injury remain. We conducted this study to evaluate the surgical efficacy and safety of a selective omission strategy for UAS use during RIRS in patients with small renal stones (<10 mm) or in cases where UAS placement is technically difficult. Materials and Methods: This retrospective study included consecutive patients who underwent single-surgeon RIRS at Changhua Christian Hospital between October 2020 and April 2023 for renal or upper ureteral stones. Sheathless RIRS was performed in patients with stones < 10 mm, or in whom insertion of a 10/12 Fr UAS was unsuccessful despite successful advancement of an 8 Fr semirigid ureteroscope, and when the surgeon estimated the procedure could be completed within 2 h. All procedures used a holmium laser with a 9 Fr or 7.5 Fr flexible ureteroscope. No patients were pre-stented, and all received postoperative double-J stenting. Results: Among 55 patients, 18 (32.7%) underwent sheathless RIRS and 37 (67.3%) underwent UAS-assisted RIRS. Stone size was significantly smaller in the sheathless group (12 mm vs. 17 mm, p = 0.001). The 3-month stone-free rate (SFR) was 66.7% in the sheathless group and 62.2% in the UAS group (p = 0.745). Operative time was similar between groups (77 vs. 85 min, p = 0.154), with no statistically significant differences in postoperative pain or length of hospital stay. In the UAS-assisted group, six patients developed febrile urinary tract infection, of whom two progressed to sepsis; all recovered after antibiotic therapy. No fever or sepsis occurred in the sheathless group. On multivariable analysis, lower calyceal stone location was independently associated with SFR, whereas UAS use was not. Conclusions: In a selected cohort (stones < 10 mm or difficult UAS insertion with an expected operative time < 2 h), sheathless RIRS was feasible and showed no statistically significant differences in SFR or perioperative outcomes compared with UAS-assisted RIRS. However, due to selection bias, stone-size imbalance, and limited statistical power, these findings should not be interpreted as procedural equivalence and require confirmation in adequately powered studies with stratified/adjusted analyses. Full article

(This article belongs to the Special Issue Intrarenal Surgery for Kidney Stones and Other Kidney Diseases)

14 pages, 377 KB

Open AccessArticle

Comparison of Mini-Percutaneous Nephrolithotomy and Flexible Ureteroscopy for Treating 1–2 cm Single Stones in Solitary Kidney: Outcomes and Renal Function Impact

by Yuehan Yang, Zhongwei Jiang, Xike Mao, Lvwen Zhang and Zongyao Hao

J. Clin. Med. 2026, 15(5), 2089; https://doi.org/10.3390/jcm15052089 - 9 Mar 2026

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Abstract

Objective: The optimal surgical approach for 1.0–2.0 cm renal stones in solitary kidney patients remains controversial. This retrospective study compared mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (f-URS) outcomes in this vulnerable population. Methods: Between June 2018 and April 2024, 50 patients with solitary kidneys and 1.0–2.0 cm renal stones underwent either mPCNL (n = 26) or f-URS (n = 24). Outcomes included 3-month stone-free rate (SFR), complications (Clavien–Dindo classification), and renal function (serum creatinine, eGFR by CKD-EPI equation) at the baseline, 72 h, and 1 month. Results: Stone-free rates were comparable (mPCNL 96.2% vs. f-URS 91.7%, p = 0.157). The f-URS group demonstrated significantly less hemoglobin decline (2.2 ± 0.9 vs. 5.7 ± 2.4 g/dL, p < 0.001) and shorter hospitalization (4.1 ± 1.1 vs. 7.8 ± 1.6 days, p < 0.001). All Grade II complications (8.3%, requiring transfusion) occurred in the mPCNL group. At 1 month, serum creatinine decreased more with f-URS (15.4 ± 7.96 vs. 8.7 ± 4.23 μmol/L, p < 0.001), with greater eGFR improvement (16.7 ± 4.7 vs. 15.4 ± 5.2 mL/min/1.73 m², p = 0.023). Conclusions: In this retrospective cohort, f-URS achieved comparable stone clearance to mPCNL alongside a superior early safety profile and better short-term renal functional preservation. These preliminary findings suggest that f-URS represents a viable nephron-sparing option for this high-risk population. However, these results are considered hypothesis-generating, and further prospective, long-term studies are required to evaluate the durability of these functional benefits. Full article

(This article belongs to the Special Issue Intrarenal Surgery for Kidney Stones and Other Kidney Diseases)

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11 pages, 452 KB

Open AccessArticle

T.O.HO.-PCNL Score for Predicting Success of Percutaneous Nephrolithotripsy: A New Score Development Study

by Şeref Coser, Okan Alkıs, Baki Numan Özkaynak, Samet Senel, Halil İbrahim İvelik, İbrahim Güven Kartal and Bekir Aras

J. Clin. Med. 2026, 15(2), 409; https://doi.org/10.3390/jcm15020409 - 6 Jan 2026

Viewed by 508

Abstract

Background/Objectives: The aim of this study was to develop a modified version of the T.O.HO. score for predicting percutaneous nephrolithotomy (PCNL) success. Materials and Methods: Patient demographics, stone-related parameters, perioperative findings, and postoperative outcomes were recorded. We reviewed the data of 155 patients who underwent percutaneous nephrolithotomy (PCNL) between October 2020 and December 2024. Patients were divided into two groups: success and failure. While preserving the validated components of the existing T.O.HO. score, the stone location parameter was restructured to more accurately reflect the anatomic challenges inherent to PCNL and was scored to include locations in the renal pelvis, upper, middle, lower and multiple calyces. The performance of the T.O.HO.-PCNL score in predicting surgical success was evaluated using ROC curve analysis. Results: The overall success rate was 65.8%. Patients in the successful group had smaller stone sizes and shorter operative times and hospital stays (p < 0.01). Preoperative hydronephrosis was more commonly observed among unsuccessful group (p < 0.05). The T.O.HO.-PCNL score was significantly lower in the successful group compared with the unsuccessful group. (p < 0.05). In the multivariate logistic regression analysis, stone size emerged as an independent predictor of PCNL success (OR: 1.076; 95% CI: 1.032–1.122; p < 0.001). ROC curve analysis demonstrated that the T.O.HO.-PCNL score had predictive value for PCNL success, with an optimal cut-off of 8.5 (AUC: 0.598; 95% CI: 0.506–0.690; p = 0.046). Conclusions: The T.O.HO.-PCNL scoring system is a promising nomogram for predicting stone-free status after PCNL in preoperative evaluation. Full article

(This article belongs to the Special Issue Intrarenal Surgery for Kidney Stones and Other Kidney Diseases)

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11 pages, 909 KB

Open AccessArticle

Optimizing the Scope–Sheath Compatibility in RIRS: Matching of Reusable and Single-Use Flexible Ureteroscopes with FANS

by Petrisor Geavlete, Razvan Multescu, Cosmin Ene, Bogdan Buzescu and Bogdan Geavlete

J. Clin. Med. 2025, 14(20), 7215; https://doi.org/10.3390/jcm14207215 - 13 Oct 2025

Cited by 1 | Viewed by 859

Abstract

Background/Objectives: Adoption of single-use ureteroscopes (SU) and flexible and navigable suction ureteral access sheaths (FANS) have improved flexible ureteroscopy (fURS) efficiency and safety. However, the impact of scope–sheath pairing is less studied. This study aims to compare four scope–sheath configurations using reusable ureteroscopes (RU) and SU with either 11/13Fr or 12/14Fr FANS. Methods: We retrospectively evaluated 184 patients undergoing fURS for kidney solitary stones of 10–25 mm. Patients were manually matched across four groups: RU-11/13FANS, RU-12/14FANS, SU-11/13FANS, and SU-12/14FANS (46 patients in each). The endpoints were 30-day stone-free rate (SFR), operative time, surgeon-reported visibility (image clarity and procedural continuity) and postoperative complications. Results: Operative time was significantly shorter in single-use scope groups (p < 0.001). Visibility scores were highest in SU-12/14FANS and lowest in RU-11/13FANS across all subdomains. SFR was higher in SU groups. SU-11/13FANS had a significantly higher SFR than RU-12/14FANS (p = 0.027). In the reusable group, the use of 12/14Fr FANS was associated with a lower SFR compared to the 11/13Fr configuration. Complication rates were low (8.2% overall) and comparable among groups. Conclusions: Pairing SU with 12/14Fr FANS provided optimal visibility and good stone clearance without increasing complications. In contrast, RU paired with 12/14Fr FANS showed slightly reduced efficacy, possibly due to impaired maneuverability. The scope–sheath interaction influenced outcomes differently across scope types, underlining the importance of their matching in fURS. Full article

(This article belongs to the Special Issue Intrarenal Surgery for Kidney Stones and Other Kidney Diseases)

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