Muljibhai Patel Urological Hospital, Nadiad, Gujarat , India
Introduction: RIRS as a modality for renal stone management is safe, efficacious and well established for small or mid-sized stones. There have been many comparisons on lasers, scopes, accessories and even patient position and their role in RIRS surgery. As technology and technical expertise for RIRS improves there is no evidence if the gender has any influence on the aforementioned variables and on SFR and complication outcomes when performing RIRS In this study as part of TOWER initiative our primary aim is to evaluate possibly for the first time the role that gender has in performing flexible ureteroscopy from a large series of patients. Methods: This study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021. Twenty centres with expert endourologist performing RIRS across the globe contributed to creating the “FLEXOR” registry of 6669 patients whose data were analyzed by dividing patients into two groups male and female. Evaluation included baseline characteristics of the patients, such as age, race and stone characteristics. We also registered perioperative findings, results and complications according to the Clavien Dindo classification. Results: A total of 6669 patients were included, 4407 (66.1%) were male and 2262 (33.9%) were female. Stone location and mean stone size was comparable in both groups (10.24 mm in males and 10.17 mm in females). Females compared to male patients had lower pain at initial presentation but significant higher fever and positive urine culture rates (12% vs 8% and 37% vs 34% respectively). The results showed that females had a slight longer hospital stay (3.8 vs 3.5 d) p < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (p = 0.032)). In addition, overall complications were also slightly but significantly higher in women, with a rate of 15.74% in females and 14% in males (p =0.042), at the expense of significant higher fever rates 6.9%vs 5.7% and a higher but not significant higher sepsis rate (1.46%. vs. 1.1%). A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual factors and overall complications. Conclusions: Our real life Global study reflects that female gender may have a correlation with slight increased residual fragment and overall low grade complications. However, even symptomatic women at presentation with fever and positive cultures can safely be treated by RIRS with no increased rate of sepsis with appropriate care. Our global study reiterated that lower pole, multiple and large stone volumes will have a higher residual fragment incidence in immediate post-operative period and need to be followed up appropriately. SOURCE OF Funding: None
