Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi

Abstract

Objective To assess the ef®cacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are too large to treat with extracorporeal shock wave lithotripsy (ESWL). Patients and methods Thirty patients (22 men and eight women, mean age 43 years, range 18±62) with a renal stone burden of >2 cm were selected for laser treatment. The stones were in the renal pelvis in 16 patients, lower calyx in ®ve, middle calyx in two, upper calyx in one and multiple pelvic and calyceal in six. Lithotripsy was undertaken using a holmium laser through 550 mm and 200 mm laser ®bres passed through a semi-rigid ®bre-optic long ureteroscope or the actively de¯ectable¯exible ureteropyeloscope, respectively. Success was de®ned as total fragmentation of the stone to <2 mm in diameter and/or clear imaging on renal ultrasonography and plain ®lms within the 3-month follow-up. Patients in whom the treatment failed received either alternative therapy or complementary ESWL.Results Endoscopic access and complete stone fragmentation was achieved in 23 of the 30 patients (77%). The treatment failed in seven patients because of poor visualization, the initial presence of stones in, or migration of their large fragments to, an inaccessible calyx. There were no major intraoperative complications. Minor complications after treatment included haematuria that persisted for 2 days in one patient and high-grade fever in two patients; all were treated conservatively. Conclusion Large renal calculi that are not amenable to ESWL monotherapy can be safely and effectively treated with a retrograde endoscopic technique that seems to compete well with the more invasive percutaneous or open surgical manoeuvres.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm

“…[2] Although this procedure has a high stone-free rate, it has significant complications despite technological advancements. [5][6][7] The low success rate of ESWL and the high morbidity of PCNL in lower calyx stones directed investigators to other alternatives. RIRS is a reasonable alternative to PCNL and ESWL in lowvolume lower calyx stones, because it has a lower complication rate compared with PCNL and a stone-free rate similar to that of ESWL.…”

Retrograde Intrarenal Surgery versus Percutaneous Nephrolithotomy for Treatment of Renal Stones >2 cm: A Meta-Analysis

“…Several single-institution case series of RIRS for large renal stones have been reported [28,29,30,31,32,33,34,35,36]. In 1998, Grasso et al [28] first reported 48 patients with upper urinary tract and minor staghorn calculi >2 cm who underwent RIRS, with an 81% (34 of 45 renal and 20 of 21 ureteral) stone-free rate in a single procedure.…”

“…Second-stage procedures were carried out in 18 patients (8 of 15 large renal and 1 of 3 complex ureteral stone burdens), and the success rate increased to 94% without intraoperative complications. The study by El-Anany et al [29] showed that stone fragmentation was achieved in only 23 (77%) patients because of poor visualization. In recent years, more and more doctors have been able to skillfully operate the flexible ureteroscope and determine the efficacy of ureteroscopy as an alternative to PCNL to tackle large renal stones.…”

Comparison of ureteroscopy and percutaneous nephrolithotomy for renal pelvic stones over 2 cm

“…Technological improvements in the new generation of ureteroscopes such as small caliber URSs and digital optics and advances in laser lithotripsy have made the use of RIRS for renal stones more popular [4,5]. It has been widely accepted that RIRS procedures significantly decreased morbidity rates in the management of renal stones [17,18]. RIRS has good efficacy and less morbidity in the treatment of large renal stones.…”