Modular flexible ureteroscope and Holmium laser lithotripsy for upper urinary calculi less than 2 cm: A report of 117 cases / 第二军医大学学报

ABSTRACT

Objective To evaluate the clinical value of the PolyScope™ endoscope system (F8 modular flexible ureteroscope) in treatment of upper urinary calculi less than 2 cm in diameter. Methods A total of 117 patients with upper urinary calculi, who were hospitalized in Xinhua Hospital from Nov. 2010 to Aug. 2012, were recruited in this study. The patients included 71 males and 46 females, aging from 20-86 (average age49.7±13.9). Ninety-six patients had single calculi and the rest 21 had multiple calculi; 61 patients had left calculi and 56 had right calculi. The mean diameter of calculi was (1.19±0.34) cm. Twenty-two patients had been indwelled with D-J tube in advance under ureteroscope for 2-8 weeks, including 13 with ureteral stenosis, 7 with urinary tract infection and 2 with renal insufficiency. General or spinal anaesthesia were used and the patients were at cutting stone position. F8/9.8 rigid ureteroscope was inserted to the ureter for dilating the ureter, and the Holmium laser lithotripsy was performed for upper ureteral stone in situ. After dilating the ureter, the guide wire was inserted under the direct vision of F8/9.8 rigid ureteroscope, and then the F12/14 flexible ureteral access sheath was placed along the guide wire. Finally, further examination and Holmium laser lithotripsy were performed by F8 "PolyScope" modular flexible ureteroscope. The power of the laser was set at 1.0 J and the frequency was 10-20 Hz. F6 D-J tube was regularly indwelled for 4 weeks after operation and Forley urethral tube was indwelled for 1 to 7 days. KUB was performed 1 day after operation to detect the result of lithotropsy and the position of D-J tube. KUB was performed again 2-4 weeks after operation in some patients. Extracorporeal shock wave lithotripsy (ESWL) should be performed if the diameter of residual stones was larger than 6 mm. Results Lithotripsy was successfully performed in 103 patients, with the operation time being 25-85 min (mean time [46±14] min) and with less bleeding. Four patients developed high fever after operation and were cured after anti-inflammatory treatment. There was no ureteral perforation or septicaemia. The single stone-free rate of single-pass lithotripsy was 88% (103/117); when combined with ESWL, the total stone-free rate was 95.7% (112/117).Conclusion F8 modular flexible ureteroscope is safe, convenient, and effective for the lithotripsy of the upper urinary calculi.