Impact of Surgical Position on Stone-Free Rates in Retrograde Intrarenal Surgery

Ondokuz Mayıs University128 enrolled

Overview

The goal of this clinical trial is to determine whether the surgical position during retrograde intrarenal surgery (RIRS) affects stone-free rates in adults with kidney stones. The main questions it aims to answer are: * Does the modified lithotomy position result in a higher stone-free rate compared to the standard lithotomy position? * Are there differences in complication rates between the two surgical positions? Researchers will compare patients undergoing RIRS in the standard lithotomy position to those in the modified lithotomy position (30-degree Trendelenburg with elevated surgical side) to assess its impact on stone clearance and surgical outcomes. Participants will: * Be randomly assigned to one of two surgical positions * Undergo RIRS with standard surgical procedures * Have follow-up imaging to assess stone clearance after surgery This study aims to improve surgical techniques and patient outcomes in kidney stone treatment.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

128

Conditions

Stone, Kidney Stones, Kidney Stone;Renal

Interventions

The T-Tilt positionPROCEDURE

The T-Tilt position is a modified lithotomy position used during retrograde intrarenal surgery (RIRS). In this position: The patient is placed in a 30-degree Trendelenburg position, meaning the head is slightly lower than the feet. The surgical side is elevated at a 30-degree angle to improve access to the kidney. This modified positioning is designed to enhance stone clearance, particularly by facilitating the movement of stone fragments away from the lower kidney calyces, where residual stones often remain. Researchers will compare this position to the standard lithotomy position to determine its impact on stone-free rates and surgical outcomes.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Presence of single or multiple kidney stones, with the largest stone ≤2 cm * Age ≥18 years * Provided written informed consent to participate in the study * Indicated for retrograde intrarenal surgery (RIRS) as a treatment approach Exclusion Criteria: * Severe cardiovascular disease (e.g., heart failure) * Congenital kidney anomalies (e.g., horseshoe kidney, ectopic kidney) * Concurrent ureteral stones * Pregnancy or planning pregnancy * History of previous kidney surgery on the same side * Active urinary tract infection (UTI) * Coagulopathy or use of anticoagulant therapy that cannot be stopped before surgery

Outcomes

Primary Outcomes

Stone-Free Rate After Retrograde Intrarenal Surgery

The percentage of participants with no residual kidney stones (≤4 mm fragments) on non-contrast computed tomography (CT) at 6 weeks postoperatively.

Time frame: 6 weeks post-surgery

Secondary Outcomes

Postoperative Complication Rate

he percentage of participants experiencing any postoperative complications, classified according to the Clavien-Dindo grading system.

Time frame: Within 30 days post-surgery