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Objective: To investigate the outcomes of retrograde intrarenal surgery (RIRS) for large renal calculi, and to identify factors that influence the stone-free rate after RIRS for renal stone burden greater than 2 centimeters. Materials and Methods: This retrospective chart review included patients who underwent RIRS for renal calculi greater than 2 centimeters in size during January 2015 to December 2016 at Siriraj Hospital Thailand's largest national tertiary referral center. Data were collected and compared between those having and not having residual stones greater than 2 cm in diameter. Results: The present study included 100 eligible cases. The most common site was at lower calyces (42%). The mean stone burden size was 31.43 mm (range: 20 to 140). The average operative time was 62 minutes (range: 20 to 150), and the mean hospital length of stay was 2.7 days (range: 1 to 22). The most common stone composition was calcium oxalate monohydrate (37%), followed by calcium phosphate (23%). The success rate was 84% and 94% after the 1st session and 2nd session of RIRS, respectively. The factors that were found to predict residual stone after RIRS were stone burden greater than 35 mm in size (odds ratio [OR]: 5.86, 95% confidence interval [CI]: 1.77 to 19.57; p = 0.004) and lower pole location (OR: 1.97, 95% CI: 1.039 to 3.742; p = 0.038). Sepsis was found in 6 patients, all of whom were successfully treated with intravenous antibiotic, except for one mortality in an immunocompromised patient. Conclusion: RIRS is a promising treatment option for renal calculi with large stone burden. Large kidney stones (>2 cm) can be treated with high success rate and low morbidity. The most significant predictors of residual calculi are stone burden more than 35 millimeters in size and lower pole location. [ABSTRACT FROM AUTHOR]

Objective: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male children. PUV has a broad spectrum of clinical presentations and can develop into renal failure at varying ages. Many previous studies reported serum creatinine to be a useful prognostic factor and a practical method for predicting long-term renal outcome, but the cut-off value is still unclear. The authors aimed to identify the optimum cut-off value of initial creatinine (iCr) as a prognostic factor for Chronic Kidney Disease (CKD), and to estimate the renal failure-free survival (RFFS) rate in PUV patients. Materials and Methods: Male pediatric patients who were diagnosed with PUV at Siriraj Hospital (Bangkok, Thailand) from January 2005 to December 2016 were retrospectively reviewed. Statistical methods, including receiver operating characteristic (ROC) curve analysis, Kaplan-Meier method, log-rank test and Cox proportional hazards regression were used. Statistical significance was defined as p<0.05. Results: Of the 69 patients identified, 41 were included. The median age at intervention was 240 days (range: 2 to 3,240). CKD was found in 48.7% at the last follow-up, the optimal cut-off value for initial creatinine associated with CKD was 0.7 mg/dL, and median renal failure-free time was 57 months. Multivariable analysis revealed initial creatinine to be the only independent predictor of longterm renal outcome in PUV patients. Conclusion: Initial creatinine was found to be an independent predictor of long-term renal outcome in PUV patients. An initial creatinine cut-off value of 0.7 mg/dL or greater is significantly associated with high risk of developing CKD (adjusted HR: 4.4, 95% CI: 1.4 to 13.8; p = 0.011). [ABSTRACT FROM AUTHOR]