Retrograde ureteropyeloscopic holmium laser lithotripsy for shockwave refractory renal calculi

ABSTRACT

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