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T ED
Several studies reported that mul1stage Retrograde Intra-Renal Surgery (RIRS) is D A Parameter p
a safe and efficacious treatment op1on for renal stones, with a high stone-free UP A Age p=0.3844*
rate, fewer complica1ons and a rapid learning curve. D A T
Size p= 0.0002*
The aims of this study were: Location p=0.0013 #
(1)  to design a standardised and original classifica1on system of kidney Hardness p=0.0006*
stones suitable for RIRS based on their features and on the anatomical
aspect of the upper urinary tract (ScorDiS-RIRS: Scoring Difficul-es for Number p=0.0471*
Stones“-RIRS); Upper Urinary Tract Morphology p=0.0001*
#
(2)  to evaluate the ability of this classifica1on system in predic1ng the Ureteral Morphology p=0.0028
“complexity” of performing RIRS on a prospec1ve series of pa1ents. Re-operation p=0.1422*
In order to propose a reliable, simple and “objec1ve” predic1ve score of Presence of DJ in situ p=0.6261*
opera1ve difficulty for RIRS we based our analysis on the correla1ons between 2 #
* Yeats’ χ - Fisher’s test
preopera1ve objec1ve parameters and a self-assessment of “technical difficulty”
performed by a single skilled surgeon.
UPDATED
ScorDiS – RIRS Groups
DATA
ScorDis Groups Complexity
We prospec-vely evaluated 108 Defini-ons of different morphologies of the Easy Intermediate Difficult
pa1ents who underwent RIRS for upper urinary tract
1 (<10) 68.2% 31.8% 0%
renal stones between May and
December 2016. All procedures We evaluated the upper urinary tract 2 (10-11) 28.6% 48.6% 22.8%

were performed by the same skilled morphology iden1fying five possible 3 (>11) 0% 41.4% 58.6%
surgeon (PB). “silhoue[es” (see Figure): p < 0.00001

Preopera1vely, all pa1ents were A: normal;

studied using computed B: Caliceal diver1culum;
With this preliminary analysis, we
tomography (CT) or magne1c C: dila1on of calices, pelvis and ureter; demonstrated that ScorDis-RIRS
resonance imaging (MRI). D: dila1on of only calices; is a simple scoring system that
For each pa1ent data regarding the E: hydronephrosis (with ureteropelvic can be used to predict the
age, size of stone, loca1on, junc1on obstruc1on). complexity of RIRS procedure.
composi1on/hardness (according to We also analysed the ureteral morphology, Further experiences are needed
Hunsfield Units at imaging), number with three possibili1es: to validate this scoring system.
of stones, previous or not ureteral a: normal ureter; ScorDis-RIRS could also be useful
procedures, presence or not of in training programs for selec1ng
b: ureteral stricture;
ureteral stent “in situ” were a surgeon with an appropriate
c: ureteral dila1on.
collected.
level of exper1se, and thereby
Opera1ve 1me and intra/ The surgeon (PB) was asked to assign avoiding assigning a resident
postopera1ve complica1ons (immediately at the end of each procedure) surgeon in training (without the
according to Clavien-Dindo a degree of “difficulty”, classifying each RIRS necessary level of skill) to an
classifica1on were recorded. as “easy”, “intermediate” or “difficult”, overly complex case.

according to his experience.

fabrizio.dalmoro@unipd.it