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    Virgin ureter vs. non-virgin ureter? A comparative analysis on complications and failure of retrograde intrarenal surgery: a multicentre case-control study from RIRSearch Group
    (Springer, 2025) Teke, Kerem; Cinar, Naci Burak; Cinar, Onder; Akgul, Murat; Basatac, Cem; Simsekoglu, Muhammet Fatih; Cakir, Hakan
    It is unclear whether ureteral virginity has an effect on retrograde intrarenal surgery (RIRS). We aimed to evaluate the impact of ureteral virginity on RIRS outcomes in a multicenter study. Data from the RIRSearch study group database were retrospectively reviewed. Patients with a history of endoluminal interventions or extrinsic ureteral surgery were categorized as having a non-virgin ureter, while those without such histories were classified as virgin ureters. Case-control matching was performed based on age, gender, uretral access sheath size, and stone characteristics. Demographic, clinical, surgical and complication data were compared after-matching. A total of 894 procedures were included, with 119 (13.3%) involving non-virgin ureters. Pre-matching, the non-virgin ureter group had higher mean age (50.6 +/- 13.2 vs. 46.6 +/- 13.6 years) and Charlson comorbidity index >= 2 (51.3% vs. 40.4%). In addition, number of stones, total-stone volume and rate of multiple stone localization were significantly higher in non-virgin ureter group. Operation time, hospital stay, surgical failure, need for auxiliary treatment, and perioperative complications were significantly higher in non-virgin ureter group (p < 0.05). After case-matching, perioperative complications (18.7% vs. 5.3%), hospital stay (1.54 +/- 1.30 vs. 1.18 +/- 0.98 days), and auxiliary treatment requirements (20% vs. 8.4%) remained significantly higher in non-virgin ureter group (p < 0.05). There was no significant difference in postoperative complication rates (17.3% vs. 19.8%) or surgical failure rates (36% vs. 26%). Non-virgin ureters were associated with higher perioperative complication rate, longer hospital stays and increased need for auxiliary treatments during RIRS. Patients with non-virgin ureters may be informed about these potential risks before surgery.