Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotripsy

Abstract

Introduction: Ureteroscopic lithotripsy has become the first choice for the treatment of middle and lower ureteral stones, but it still has a certain rate of surgical failure. Here we aimed to determine the factors that may affect the success rate of holmium laser ureterolithotripsy (HLU) and provide the basis and guidance for its future use. Aim: To evaluate the risk factors for HLU failure. Material and methods: The clinical data of 385 patients undergoing holmium laser ureterolithotripsy from 2009 to 2012 were retrospectively reviewed to analyze the impact of gender, age, stone side, stone size, stone location, stone number, degree of hydronephrosis, stone impaction, previous extracorporeal shock lithotripsy (ESWL), and associated urinary tract infection (UTI) on the success or failure of surgery. Results: Surgical success was achieved in 338 (87.8%) patients versus surgical failure in 47 (12.2%) patients. Univariate analysis revealed that the degree of hydronephrosis (p = 0.024), stone impaction (p = 0.003), stone location (p = 0.012), and previous ESWL (p = 0.037) were risk factors for surgical failure. Multivariate logistic regression revealed that stone impaction (odds ratio (OR) = 2.66; p = 0.018) and stone location (OR = 2.11; p = 0.013) were significantly associated with surgical failure. Since some cases of ureterostenosis developed postoperatively, we continued follow-up. The patients had the stent for a year and underwent regular follow-up checks until 5 years. No cases of ureterostenosis recurred. Conclusions: Ureteroscopic lithotripsy is a safe procedure with few complications. Stone impaction and proximal location are the risk factors for its failure.

Laser Lithotripsy for the Management of Ureteric Calculus

“…3,9 There was no hydronephrosis in 19.5% cases and most of the patient with hydronephrosis had mild degree of hydronephrosis (54.3%). Similar to our study, a study done by Zheng et al 18 also showed that most of the patient had either no or mild hydronephrosis.…”

Clinical efficacy analysis of tip‑flexible suctioning ureteral access sheath combined with disposable flexible ureteroscope to treat 2-4 cm renal stones

“…In order to minimize surgical complications, certain studies have employed modi ed ureteroscopes equipped with suction sheaths. However, the distal end of these sheaths can only reach the pelviureteric junction and cannot extend into the renal pelvis or calyces, leading to low e ciency in stone retrieval [28].Moreover, the opening of the UAS is susceptible to obstruction, resulting in elevated pressure in the renal pelvis and re ux, thereby increasing the risk of bleeding and infection [31].Previous research has indicated that terminal bendable negative pressure suction sheaths, in comparison with conventional ureteroscopic sheaths, offer the advantage of exible entry into calyceal stones, allowing the front end of the sheath to be secured in the speci c calyx for accurate stone fragmentation and retrieval, with the aim of reducing residual stones and recurrence [28,32].The simultaneous suction feature not only aids in stone aspiration but, importantly, enables the prompt elimination of irrigation uids during surgery, maintaining a low-pressure environment in the renal pelvis to prevent severe intraoperative and postoperative infections [30].…”

In vitro renal calculi destruction by a high-frequency glow discharge plasma

“…For example, ultrasound lithotripsy uses only rigid probes and rigid endoscopes, and its scope of application is mainly limited to kidney stones. Contact lithotripsy (pneumatic or electrokinetic lithotripters) is one of the most effective and safe methods of contact destruction of stones 11 , 12 . At the same time, the use of such lithotripters is also limited by rigid endoscopes, and retrograde stone propulsion in transurethral lithotripsy is a disadvantage of the method 11 – 13 .…”