RESUMO
To assess the efficacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are refractory to treatment with extracorporeal shock wave lithotripsy [ESWL]. 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. 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. Ureteroscopic laser lithotripsy can be used effectively and safely to treat upper tract stones unresponsive to SWL. Patients with stone burden > 10 mm and those with an abnormal renal anatomy require more than one procedure