Flexible Ureteroscopy and Laser Lithotripsy for Stones >2 cm: A Systematic Review and Meta-Analysis

Abstract

In experienced hands, FURSL can successfully treat patients with stones >2 cm with a high stone-free rate and a low complication rate. Although the studies are from high-volume experienced centers and may not be sufficient to alter everyday routine practice, this review has shown that the efficacy of FURSL allows an alternative to PCNL.

Single session vs two sessions of flexible ureterosopy (FURS) for dusting of renal pelvic stones 2-3 cm in diameter: Does stone size or hardness play a role in number of sessions to be applied?"

“…[1,4,5] It has been postulated previously that FURS can be associated with lower SFR, and need for multiple treatment sessions, and shorter fluoroscopy times. [14] However, development in endoscopic technology and introduction of new generations of flexible scopes in addition to existing comorbidities in some patients who cannot tolerate PCNL made FURS a more appealing surgical option.…”

“…[ [4][5][6] The surgical outcomes in terms of operative time, number of sessions, and volume of energy required for disintegration depend on the size [7,8] and composition of the stones. [9] Calcium phosphate, and calcium oxalate monohydrate stones are the hardest to disintegrate.…”

Retrograde intrarenal surgery for renal stones - Part 2

“…Aboumarzouk et al [16] published a meta-analysis of 9 studies performed between 1990-2011, which included 445 patients (460 renal units) with big kidney stones, and they found median stone diameter as 2.5 cm, median SFR as 93.7% after a median of 1.6 procedures, and general complication rate as 10.1% (major 5.3%, minor 4.8%). Major complications were defined as steinstrasse, subcapsular hematoma, obstructive pyelonephritis, cerebrovascular accident, acute prostatitis and hematuria causing cloth retention; where minor complications were hematuria recovering spontaneously and postoperative fever.…”

Retrograd İntrarenal Cerrahi; Hangi Hastaya?

“…Ayrıca PNL'nin kontrendike olduğu durumlarda 2 cm'den büyük taşlarda da RİRC'nin ilk tedavi seçe-neği olabileceği belirtilmektedir. Bunun yanında PNL'nin cerrahı ve hastayı korkutan komplikasyonları nedeniyle, son yıllarda 2 cm'den büyük taşlarda da birden fazla seans ihtimalini göz önünde bulundurarak RİRC'in etkili bir yöntem olduğunu bildiren metaanalizler de mevcuttur (8).…”