Efficacy, safety, and Outcomes of Retrograde Intrarenal Surgery for Upper Ureteric and Renal Stones: A Single-Center Retrospective Study of 382 Cases

Open Access

Abstract

Introduction: Retrograde intrarenal surgery (RIRS) with holmium laser lithotripsy has become a primary minimally invasive treatment for upper urinary tract stones. However, large singlecentre series reporting both efficacy and safety for stones up to 3 cm remain limited. Objective: To evaluate the efficacy, safety, and perioperative outcomes of RIRS for upper ureteric and renal stones. Methods & Materials: This retrospective singlecentre study included 382 adult patients (62.3% male, mean age 46.2 years) with symptomatic upper ureteric or renal calculi ≤3 cm who underwent RIRS between July 2018 and January 2026. The primary outcome was stonefree rate (SFR) defined as no residual fragments >2 mm at 4week followup. Secondary outcomes included complications graded according to the Clavien-Dindo classification, operative time, laser time, hospital stay, and re-intervention rate. Results: The overall SFR was 92.5% (353/382), with residual fragments >2 mm in 7.5% (29/382). Mean total operative time was 69.3 minutes, mean laser time 37.5 minutes, and mean postoperative hospital stay 2.5 days. Intraoperative complications included pelvicalyceal bleeding requiring transfusion (1.3%), pelvicalyceal injury (2.8%), and ureteric injury related to the ureteral access sheath (3.9%). Postoperative complications were mostly mild: fever requiring medication (16.7%, grade II), persistent haematuria (10.9%, grade I), and sepsis requiring ICU admission (0.78%, grade IV). No grade V (death) complications occurred. Reintervention for residual fragments was performed in 7.5% (repeat RIRS 7.0%, PCNL 0.5%). Conclusion: RIRS with holmium laser lithotripsy is highly effective and safe for upper ureteric and renal stones up to 3 cm, achieving a 92.5% stonefree rate with low major morbidity and short hospital stay. These results support RIRS as a first-line minimally invasive option in high-volume centers.