Holmium laser lithotripsy with semirigid ureterorenoscopy in treatment of upper ureteral and renal pelvis stones under spinal anesthesia

Abstract

Extracorporeal shockwave lithotripsy and especially flexible ureterorenoscopy (URS) are first-choice treatments of upper ureteral and renal pelvis stones. In our study, we aimed to demonstrate that the treatment of upper ureteral and renal pelvis stones smaller than 2 cm could be performed by semirigid URS under spinal anesthesia. The data of 292 patients were retrospectively analyzed. Stones were localized in upper ureter and renal pelvis in 191 (65.4%) and 101 (34.6%) patients, respectively. The stone-free rate was found to be 72.6%. The final stone-free rate was 95.2% after additional treatments administered to 80 patients with residues. While no peri-operative complication was observed, hematuria was observed in three patients during the post-operative period, high fever was observed in 27 patients and sepsis was observed in four patients. It is a well-known fact that flexible URS is the first-choice surgical method in the treatment of upper ureteral and renal pelvis stones. In the current study, we aimed to investigate whether laser lithotripsy with semirigid URS could also be a good and cheap alternative in clinical practice, and if upper urinary tract surgeries could be performed with spinal anesthesia especially in patients with a high risk of general anesthesia. Level of evidence:

Retrograde Intrarenal Surgery vs Mini-Percutaneus Nephrolithotomy in the Management of 10-20 Mm Lower Pole Kidney Stones: A Propensity Matched Analysis

“…Yeni nesil fleksibl üreterorenoskoplar ile RİRC, düşük hacimli böbrek taşları için tercih edilen bir tedavi seçeneği olarak ortaya çıkmıştır (8). Ancak son yıllarda, bu yaklaşım, daha az komplikasyon ve daha az morbidite nedeniyle büyük taşların tedavisinde de önerilmektedir (9,10). RİRC, üriner sistem taş hastalığının cerrahi tedavisinde hızla etkili ve güvenli bir tedavi yöntemi haline gelmektedir (8).…”