Retrograde Ureteropyeloscopic Holmium Laser Lithotripsy for Shockwave Refractory Renal Calculi
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- Category: Vol. 77, March 2009
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Retrograde Ureteropyeloscopic Holmium Laser Lithotripsy for Shockwave Refractory Renal Calculi,HAMDY M. IBRAHIM, AHMAD M. AL-KANDARI, YEHYA H. EL-SHEBINI and ENMAR I. HABIB
Abstract
Objectives: To assess the efficacy and safety of the retro-grade ureteropyeloscopic holmium laser for treating renal stones that are refractory to treatment with extracorporeal shock wave lithotripsy (ESWL).
Materials and Methods: A total of 23 patients (4 females and 19 males) with a mean age of 42.7±9.8 years (range 27 to 63 years) underwent flexible ureteroscopy and holmium: YAG laser lithotripsy. They had been treated with a mean of 2.87 previous SW sessions. Mean stone size was 1.23±0.4cm (range 0.5 to 2.3cm) and the mean number of stones per patient was 2 stones (range 1 to 6 stones) for a total of 45 stones overall. Nineteen patiets had intrarenal stones, 3 had combined ureteral and renal stones and one had ureteral stone. Success was defined as stone-free status or residual fragments less than 3mm and it was assessed by postoperative abdominal radiography, CT or ultrasonography.
Results: The overall success rate of stone fragmentation was 78.2%. Eighteen patients had no stone fragments or residual fragments less than 3mm that were expected to pass spontaneously. Of the 23 patients 4 had lower pole residual stones more than 5mm in size, 3 of them underwent second ureteroscopic procedure and one underwent PCNL as the stones were not accessible because of lower pole infundibular stricture. After the second treatment, the success rate reached 91.3%. There were no major complications, 3 patients had postoperative fever and significant irritative bladder symptoms secondary to the internal stent in 5 cases (21.7%). Mean operative time was 72.39±22.25 minutes and mean hospital stay was 3.22±1.27 days.
Conclusions: Ureteroscopic laser lithotripsy can be used effectively and safely to treat upper tract stones unresponsive to SWL. Patients with stone burden >10mm and those with an abnormal renal anatomy require more than one procedure.