{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:02:26Z","timestamp":1790341346201,"version":"4.1.0"},"reference-count":25,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Objective: To evaluate the impact of stone multiplicity on stone-free rates (SFR), complication rates, and perioperative outcomes following retrograde intra-renal surgery (RIRS) for renal calculi.\nMaterials and methods: A retrospective cohort study on 198 patients who underwent RIRS with holmium laser lithotripsy at a tertiary center from January 2020 to December 2024. Patients were stratified into single-stone (n = 100) and multiple-stone (n = 98) groups. The primary outcome was stone-free status on postoperative imaging. Independent predictors were assessed using Firth\u2019s penalized logistic regression to account for low event rates.\nResults: The overall SFR was 93.0% (184\/198), with comparable rates between the single-stone and multiple-stone groups (94.0% vs. 91.8%, p = 0.591). Residual fragments (&gt; 4 mm) were more frequent in the multiple-stone group (8.2% vs. 3.0%, p = 0.132), although this did not reach statistical significance. The overall complication rate was low (4.5%) and comparable between groups (6.0% vs. 3.1%, p = 0.498). On multivariate analysis, stone multiplicity was not an independent predictor of stone-free status (OR 0.521; p = 0.334).\nConclusions: RIRS demonstrates comparable efficacy and safety for single and multiple renal stones, supporting its use on a viable treatment option in patients with stone multiplicity. While statistical significance was not observed, the study was adequately powered (&gt; 80%) only to detect absolute differences of approximately 15% or greater. Therefore, the absence of statistical significance should not be interpreted as evidence of clinical equivalence, and larger adequately powered studies are warranted to determine whether smaller between-group differences exist.<\/jats:p>","DOI":"10.4081\/aiua.2026.15733","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:48:35Z","timestamp":1788947315000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical impact of stone multiplicity on outcomes of retrograde intra-renal surgery"],"prefix":"10.4081","volume":"98","author":[{"given":"Ahmed M.","family":"Abdel Gawad","sequence":"first","affiliation":[{"name":"Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2640-3425","authenticated-orcid":true,"given":"Tamer A.","family":"Abouelgreed","sequence":"additional","affiliation":[{"name":"Department of Urology, Faculty of 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