Kidney Stones, Nephrolithiasis
Conditions
Keywords
Retrograde Intrarenal Surgery, RIRS, Mechanical Ventilatio, General Anesthesia, Kidney Motion
Brief summary
This randomized clinical trial will compare four ventilation strategies during retrograde intrarenal surgery performed under general anesthesia. The study aims to determine whether reducing respiratory-related kidney movement improves surgical success and decreases perioperative complications. Eighty adult patients will be randomly assigned to standard ventilation, hypoventilation, intermittent apnea ventilation, or one-lung ventilation. Surgical outcomes and perioperative complications will be compared between groups.
Detailed description
Retrograde intrarenal surgery is commonly performed under general anesthesia, but respiratory movement may interfere with kidney stability during the procedure. This prospective, randomized, single-center trial will compare standard ventilation, hypoventilation, intermittent apnea ventilation, and one-lung ventilation in adult patients undergoing retrograde intrarenal surgery. The primary objective is to determine whether different ventilation strategies improve surgical success by reducing kidney movement. Secondary outcomes include operative time, stone access time, fluoroscopy time, laser use time, complications, length of hospital stay, and postoperative stone-free rate.
Interventions
PROCEDUREStandard Ventilation
Volume-controlled mechanical ventilation using standard ventilator settings during general anesthesia.
PROCEDUREHypoventilation
Volume-controlled mechanical ventilation using reduced tidal volume and respiratory rate during general anesthesia.
PROCEDUREIntermittent Apnea Ventilation
Intermittent apnea periods applied during selected stages of retrograde intrarenal surgery to reduce kidney motion.
PROCEDUREOne-Lung Ventilation
One-lung ventilation applied during selected stages of retrograde intrarenal surgery to reduce kidney motion.
Sponsors
Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Participants will be randomly assigned to one of four parallel ventilation strategy groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
Age 18-75 years. ASA physical status I-III. Scheduled for elective RIRS/RIRC under general anesthesia. No obstructive or restrictive pulmonary disease. No history of pneumothorax. No pulmonary mass or other significant respiratory disease. Normal coagulation parameters and not receiving antithrombotic therapy. No active urinary tract infection. Written informed consent.
Exclusion criteria
Age \<18 or \>75 years. ASA IV. Obstructive or restrictive pulmonary disease. History of pneumothorax. Pulmonary mass or significant respiratory disease. Receiving antithrombotic therapy or abnormal coagulation. Active urinary tract infection or urinary tract anatomical abnormality. Refusal or inability to provide informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kidney Motion During Retrograde Intrarenal Surgery | During surgery | Kidney motion during surgery will be evaluated and compared among the four ventilation strategies. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stone-free Rate | Postoperative Day 30 | Percentage of patients who are stone-free after retrograde intrarenal surgery. |
| Operative Time | During surgery | Total duration of surgery measured from the beginning to the end of the surgical procedure. |
| Fluoroscopy Time | During surgery | Total fluoroscopy exposure time recorded during the procedure. |
| Laser Activation Time | During surgery | Total duration of laser use during stone fragmentation. |
| Perioperative Complications | Periprocedural | Occurrence of intraoperative and postoperative complications. |
| Length of Hospital Stay | Periprocedural | Number of days of hospitalization. |
Countries
Turkey (Türkiye)
Contacts
CONTACTTuna Ertürk, MD
CONTACTHakan Emirkadı, MD
PRINCIPAL_INVESTIGATORTuna Ertürk, MD
University of Health Sciences Sultan 2. Abdulhamid Han Training and Research Hospital
Outcome results
None listed