A prospective, observational study to evaluate the efficacy of the retrograde intrarenal surgery scoring system for predicting stone-free rate following retrograde intrarenal surgery.
- 1Department of Urology, Osmania General Hospital, Hyderabad, Telangana, India.
- 2Department of Urology, Osmania Medical College, Hyderabad, Telangana, India.
Abstract
Introduction
Retrograde intrarenal surgery (RIRS) is widely performed for renal calculi; however, stone-free outcomes vary according to the stone burden and intrarenal anatomy. The RIRS scoring system was developed to objectively predict the stone-free rate (SFR) using preoperative computed tomography (CT) parameters. This study prospectively evaluated its predictive performance.Methods
In this prospective, observational study, 100 consecutive patients undergoing RIRS at a tertiary center (August 2023-March 2025) were included. Preoperative CT urography assessed stone number, cumulative diameter, density (hounsfield unit), location, renal infundibulo-pelvic angle (RIPA), renal infundibular length (RIL), and renal infundibular width (RIW). Each case received a RIRS score (4-10). Stone-free status (SFS) was assessed at 4 weeks; residual fragments >2 mm were considered failure to achieve SFS. Logistic regression identified the predictors of non-SFS and receiver operating characteristic analysis evaluated diagnostic performance.Results
The overall SFR was 78%. SFR declined with increasing score: 100% (4-5), 96% (6), 55.6% (7), 9% (8), and 0% (9-10) (P < 0.001). Larger stone burden, higher density, acute RIPA, longer RIL, narrower RIW, and higher RIRS score were significantly associated with failure to achieve SFS on the univariate analysis. The score demonstrated good discrimination (area under the curve ≈ 0.76). At a cutoff of 5, sensitivity was 51.3%, specificity was 100%, positive predictive value was 100%, negative predictive value was 36.7%, and accuracy was 62%.Conclusions
The RIRS scoring system enables effective preoperative risk stratification, accurately identifying low-risk patients with a high likelihood of clearance and high-risk cases at risk of failure, thereby supporting surgical planning and patient counseling.
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BibTeX
@article{mohanty2026prospective,
title = {{A prospective, observational study to evaluate the efficacy of the retrograde intrarenal surgery scoring system for predicting stone-free rate following retrograde intrarenal surgery.}},
author = {Subrat Mohanty and Karunya Katragadda and K Pradeep and Gurram Mallikarjuna},
journal = {Indian journal of urology : IJU : journal of the Urological Society of India},
year = {2026},
month = sep,
doi = {10.4103/iju.iju_61_26},
url = {https://europepmc.org/article/MED/42910132},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - A prospective, observational study to evaluate the efficacy of the retrograde intrarenal surgery scoring system for predicting stone-free rate following retrograde intrarenal surgery.
AU - Subrat Mohanty
AU - Karunya Katragadda
AU - K Pradeep
AU - Gurram Mallikarjuna
PY - 2026
DA - 2026/09/29
JO - Indian journal of urology : IJU : journal of the Urological Society of India
DO - 10.4103/iju.iju_61_26
UR - https://europepmc.org/article/MED/42910132
AB - Introduction Retrograde intrarenal surgery (RIRS) is widely performed for renal calculi; however, stone-free outcomes vary according to the stone burden and intrarenal anatomy. The RIRS scoring system was developed to objectively predict the stone-free rate (SFR) using preoperative computed tomography (CT) parameters. This study prospectively evaluated its predictive performance.Methods In this prospective, observational study, 100 consecutive patients undergoing RIRS at a tertiary center (August 2023-March 2025) were included. Preoperative CT urography assessed stone number, cumulative diameter, density (hounsfield unit), location, renal infundibulo-pelvic angle (RIPA), renal infundibular length (RIL), and renal infundibular width (RIW). Each case received a RIRS score (4-10). Stone-free status (SFS) was assessed at 4 weeks; residual fragments >2 mm were considered failure to achieve SFS. Logistic regression identified the predictors of non-SFS and receiver operating characteristic analysis evaluated diagnostic performance.Results The overall SFR was 78%. SFR declined with increasing score: 100% (4-5), 96% (6), 55.6% (7), 9% (8), and 0% (9-10) (P < 0.001). Larger stone burden, higher density, acute RIPA, longer RIL, narrower RIW, and higher RIRS score were significantly associated with failure to achieve SFS on the univariate analysis. The score demonstrated good discrimination (area under the curve ≈ 0.76). At a cutoff of 5, sensitivity was 51.3%, specificity was 100%, positive predictive value was 100%, negative predictive value was 36.7%, and accuracy was 62%.Conclusions The RIRS scoring system enables effective preoperative risk stratification, accurately identifying low-risk patients with a high likelihood of clearance and high-risk cases at risk of failure, thereby supporting surgical planning and patient counseling.
SN - 0970-1591
SN - 1998-3824
ER -