International Alliance of Urolithiasis guideline on retrograde intrarenal surgery
Guohua Zeng, Olivier Traxer, Wen Zhong, Palle Jørn Sloth Osther, Margaret S. Pearle, Glenn M. Preminger, Giorgio Mazzon, Christian Seitz, P. Geavlete, Cristian Fiori, Khurshid R. Ghani, Ben H. Chew, Kah Ann, Fábio C. Vicentini, Athanasios Papatsoris, Marianne Brehmer, Juan López Martínez, Jiwen Cheng, Fan Cheng, Xiaofeng Gao, Nariman Gadzhiev, Amelia Pietropaolo, Silvia Proietti, Zhangqun Ye, Kemal Sarıca
Abstract
OBJECTIVES: To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. MATERIALS AND METHODS: After a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. RESULTS: A total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. CONCLUSION: The series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.