Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review

Scotland, Kymora B.; Rudnick, Benjamin; Healy, Kelly A.; Hubosky, Scott G.; Bagley, Demetrius H.

doi:10.1089/end.2018.0069

Cited by 19 publications

(11 citation statements)

References 21 publications

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“…Despite this unfavorable factor, we achieved a final SFR of 89.5%, which is comparable to recent series by other groups and those achieved by PCNL. [ 11 , 14 ] Furthermore, in this study, 26 patients chose PCNL/ESWL or refused any further therapy after single or staged FURS, which were all regarded as FURS treatment failure. The actual SFR should be a little higher if these patients accepted subsequent FURS procedures.…”

Section: Discussionmentioning

confidence: 99%

Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater

Huang¹,

Xie²,

Huang³

et al. 2020

Medicine

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With improvements in endoscopy and laser technology, flexible ureteroscopy (FURS) has been a viable treatment option for large renal stones. Here, we share our experience of the FURS treatment for renal stones 2 cm or greater. We evaluated 251 consecutive patients who underwent FURS and holmium laser lithotripsy for renal stones 2 cm or greater between January 2015 and April 2019. Stone size was defined as the longest axis on non-contrast computed tomography. Data were retrospectively collected from electronic medical records. Patient demographics, stone clearance rates and perioperative complications were evaluated. There were 165 male patients and 86 female patients with an average age of 46.9 years (range 22–80 years). Mean stone size was 2.7 cm and the average number of procedures was 1.4 (range 1–5). The stone-free rate at the end of the first, second and third procedure was 61.9%, 82.9%, and 89.5%, respectively. The final stone-free rate decreased as stone size grows, and it was only 58.3% for kidney stones larger than 4 cm after an average of 2.3 procedures. The lowest clearance rates were observed in lower calyx calculi (87.2%) and multiple calyx calculi (83.5%). The overall complication rate was 15.1%, and the most common complication was postoperative fever (9.6%). One patient required blood transfusion, owing to postoperative coagulation disorders induced by urosepsis. Single or staged FURS is a practical treatment option for the renal stones sized 2 to 4 cm with acceptable efficacy and safety. Stone clearance rate of FURS treatment is mainly affected by stone size and location.

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Section: Discussionmentioning

confidence: 99%

Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater

Huang¹,

Xie²,

Huang³

et al. 2020

Medicine

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“…1 However, because of the potential advantages of fURS (eg not causing renal parenchymal damage and severe bleeding, applicability in patients with bleeding diathesis or those receiving anticoagulant therapy, short length of hospitalisation, and daily work routine not being restricted) and its ability to access almost all calyceal stones as a result of improvements in deflection, fURS has become a preferred method for the treatment of both proximal ureteral and renal stones. 2,20 In a recent meta-analysis, the final SFR was reported to be 89.4% in an average of 1.4 procedures performed in 2-3 cm stones, and this rate was stated to be comparable with PCNL. 21 Although complication rates of up to 16% have been reported in previous studies, most were classified as minor.…”

Section: Discussionmentioning

confidence: 99%

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone‐free status after flexible ureteroscopy in ureteral and renal stones

et al. 2021

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Objective: The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones.This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. Material methods: Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analysed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated.Results: A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (P = .025). Lower pole (reference), middle pole [odds ratio (OR) = 0.492 P = .016] and middle ureteral

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“…19,20 However, due to the potential advantages of fURS (e.g., not causing renal parenchymal damage and severe bleeding, applicability in patients with bleeding diathesis or those receiving anticoagulant therapy, short length of hospitalization, and daily work routine not being restricted) and its ability to access almost all calyceal stones as a result of improvements in deflection, fURS has become a preferred method for the treatment of both proximal ureteral and renal stones. 2,21 In a recent meta-analysis, the final SFR was reported to be 89.4% in an average of 1.4 procedures performed in 2-3 cm stones, and this rate was stated to be comparable to PCNL. 22 Although complication rates of up to 16% have been reported in previous studies, most were classified as minor.…”

Section: Discussionmentioning

confidence: 99%

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones

Polat

Danacıoğlu

Soytaş

et al. 2021

Preprint

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The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. Material Methods Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analyzed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. Results A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (p=0.025). Lower pole (reference), middle pole [odds ratio (OR)=0.492 p=0.016] and middle ureteral (OR=0.227, p=0.024) localizations, stone density (OR=1.001, p<0.001), and stone volume (OR = 1.008, p <0.001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, p < 0.001). Conclusion The T.O.HO. score effectively predicted stone-free status after fURS. However, Modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.

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Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review

Abstract: Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Cited by 19 publications

References 21 publications

Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater

Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone‐free status after flexible ureteroscopy in ureteral and renal stones

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones

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