Modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases

Abstract

To determine the safety and efficacy of modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi, a retrospective chart review of a single surgeon's 3-year modular flexible ureteroscopy experience was performed. All of the patients were treated with modular flexible ureteroscopy and holmium laser lithotripsy by a single surgeon. Stone-free status was defined as no fragments or a single fragment ≤4 mm in diameter at the 3-month follow-up. The procedure number, operative time, stone-free rates, repeat usage of the multilumen catheter, and perioperative complications were documented. The present study included 215 male patients and 167 female patients, with an average age of 48.5±13.7 years (range, 17-84 years). The mean stone size was 11.5±4.1 mm (range, 4-28 mm), and the mean total stone burden was 17.5±5.7 mm (range 15-46 mm). A total of 305 patients (79.8%) had a stone burden ≤20 mm, and 77 patients (20.2%) had a stone burden >20 mm. The mean number of primary procedures was 1.3±0.2 (range, 1-3). The stone-free rate following the first and the second procedure was 73.4 and 86.9%, respectively. The mean postoperative hospital stay was 3.1±1.2 days (range, 2-6 days). The highest clearance rates were observed for proximal ureteral stones (100%) and renal pelvic stones (88.7%), whereas the lowest clearance rates were observed for lower calyx stones (76.7%) and multiple calyx stones (77.8%). The higher the initial stone burden, the lower the postoperative stone-free rate (≤20 vs. >20 mm; 89.8 vs. 75.3%). The overall complication rate was 8.1%. The results of the present study suggest that modular flexible ureteroscopy with holmium laser lithotripsy may be considered the primary method for the treatment of renal and proximal ureteral calculi in select patients, due to its acceptable efficacy, low morbidity, and relatively low maintenance costs.

Clinical Observation of UreTron Single-Probe Ultrasonic Intracorporeal Lithotripter for Ureteral Calculi

“…Particularly in group H, the stage I clearance rate was slightly lower than the approximately 80% reported in other literature works. 11 , 12 This may have been due to the stricter criteria for residual stones defined in the present study and the fact that stone fragments drifted into the kidneys in dispersed locations and were more difficult to retrieve. Therefore, in addition to reducing the incidence of stone displacement and residual stone fragmentation, the previously described characteristics of “suction while fighting, fragmentation and clearing in one step” in group U were also advantageous in terms of the stone clearance rate due to the lower conversion rate of flexible ureteroscopy.…”

“…Particularly in group H, the stage I clearance rate was slightly lower than the approximately 80% reported in other literature works. 11,12 This may have been due to the stricter criteria for residual stones defined in the present study and the fact that stone fragments drifted into the kidneys in dispersed locations and were more difficult to retrieve. Therefore, in addition to reducing the incidence of stone displacement and residual stone fragmentation, https://doi.org/10.2147/IJGM.S325306…”

URS Konusunda Teknolojik Gelişmeler

“…Bu cihaz, tekrar kullanıla-bilir bir optik kablo, bir ışık kablosu, çalışma kanalı ve bir kumanda mekanizması ile birlikte kanalları olan tek kullanımlık multilümen endoskopik bir kateterden oluşmaktadır (Resim 4). Polyscope ile yapılan ilk sonuçlar, cihazın teşhis ve terapötik URS için güvenli ve etkili olduğunu, üriner taşların 3 cm'ye kadar olan kısmının tedavisi de dahil olmak üzere önerilebileceğini göstermektedir (19)(20)(21)(22). Maliyeti düşürmek için tek kullanımlık fleksibl URS'lerin tekrar steril edilerek de kullanılabileceği bildirilmiştir (21).…”

Management of upper urinary tract calculi in crossed fused renal ectopic anomaly

“…Ureteroscopy revealed that the left calculus was located in the left lower segment ureter ~0.5 cm from the left ureteral orifice. The calculus was subsequently fragmented with a holmium laser as previously described (16). The left ureter was completely twisted to the right side and so the ureteroscope was unable to move forward any further following intracorporeal lithotripsy.…”