Introduction and Objectives
Flexible ureterorenoscopy (URS) with the use of holmium YAG laser fibres and nitinol tipless baskets has made it possible to treat stones in all parts of collecting system of the kidney. The object of this poster is to present the efficacy and safety of flexible ureterorenoscopy in treating small and intermediate-size calculi in calices and pelvis. We report the results of 46 consecutive patients treated at our department.
Material and Methods
From march 2008 to may 2009 a total of 46 patients (27 males, 19 females; aged 22–82) underwent flexible URS for kidney stones, 6 of whom underwent second procedure for larger residual fragments. Calculi ranged from 5 to 35 mm, with 25 localized in lower calix, 5 in the middle, 3 in upper calix, 9 in the pelvis and in 9 patients the stones were in multiple calices. In 35 cases the holmium YAG laser was used, in 11 cases the stones could be extracted by the nitinol tipless basket solely. 16 of the patients have undergone at least 1 session of unsuccesful extracorporeal shock-wave lithotripsy (ESWL) and in 3 patients flexible URS was used to treat intact residual calculi after percutaneous nephrolithotomy (PCNL). In 40 cases the ureteral acces sheat (UAS) was used. All patients were given stent after the procedure.
Succes was defined as complete stone clearence or good fragmentation to 4 mm or less with plain film of kidneys used in follow-up. Operative time was 17–121 min with median of 58 min. The patients were divided in 3 groups by stone size (<10 mm, 11–20 mm and >21 mm). After one procedure of flexible URS 33 of 46 patients (71.7%) were stone-free (82.6%, 80%, 25% respectively in each group), after second procedure the stone-free rate rose to 84.8% (87%, 93.3% and 62.5% respectively). Operative time differs in groups with the median of 50, 66 and 97 min in each group. The surgeries had none to mild complications, including stent displacement in one patient and febrile reaction lasting for maximum 2 days in 4 patients (8.7%). There were no major complications.
Flexible URS is a safe procedure with high succes rate in treatment of small to mid-size kidney stones of all locations and can be regarded as an alternative to ESWL, which has lower morbidity but lower succes rate, and to PCNL, which morbidity and complication rate is higher, but is more succesful especially in the treatment of larger stones.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.