To evaluate the incidence rates of Re-look pyeloscopy’s in the management of renal stones>2cm in a large Australian tertiary stone hospital, focusing on factors that may influence repeat procedures and patient outcomes.

A retrospective analysis was performed evaluating patients who underwent pyeloscopy’s with laser lithotripsy for renal stones >2cm between January 2022 – January 2024 at Blacktown Hospital, Sydney. Data collected included baseline demographics, stone characteristics, perioperative parameters and rate of re-look procedures required. Outcomes for both initial and relook pyeloscopy’s included stone-free rates (SFR) and complications. Logistic regression was used to identify predictors of re-look pyeloscopy and sepsis.

141 patients presented with renal stones >2cm, 91% (n=129) of which required at least one re-look pyeloscopy. Predictors of re-look pyeloscopy included an initial SFR<80% (OR; 3.7, 95% CI: 1.9-5.6, P<0.001) and larger stone burden of >2.5cm (OR: 4.9, 95% CI: 2.2 – 6.7, P=0.003). The mean number of procedures patients underwent was 2.2 (IQR: 1.2-4.7). SFR. Complication rates include sepsis (n=11), stent colic (n=38), fragment colic (n=3), and renal hematoma requiring transfusion (n=1). Predictors for post operative laser sepsis included >4 re-look pyeloscopy’s (OR: 1.9, 95% CI: 0.9 – 2.4, P=0.02).

Relook pyeloscopy’s achieve a reasonable SFR with an acceptable risk profile, offering clinicians a minimally invasive option for large renal stones. However, the risk of sepsis with greater than 4 procedures should be carefully considered.