Flexible ureterorenoscopy: prospective analysis of the Guy's experience

Abstract

Objective: To report our outcomes with small diameter, actively deflectable flexible ureterorenoscopy from a prospective database. Patients and Methods: 114 flexible ureterorenoscopies were performed in 105 patients (mean age, 49.5 years; range, 19-85 years; 71 males, 34 females) over a 9-month period. Of these, 101 were for refractory stones following failed ESWL and 13 for diagnostic reasons. An Olympus URF P3 flexible ureteroscope with pressure irrigation was used. Electrohydraulic lithotripsy was used to fragment stones and the fragments were retrieved with Graspit, triradiate graspers or tipless baskets. Results: Stents had previously been placed in 53% and dilatation of the ureteric orifice was necessary in 15%. In the stone group, the median operating time was 55 min (range, 15-210 min) and the median screening time 2.2 min (range, 0.3-9.1 min). Success was defined as complete stone clearance or good fragmentation to 2 mm or less. Overall success in this group was 72.3%. There was no statistically significant difference between lower and other calyces (P = 0.83 Chi-square test). Successful outcome was achieved in 72% for stone size 10 mm or less, 80% for 11-20 mm and 50% for greater than 20 mm. Two or more procedures were needed in 8 patients. In the diagnostic group, the median operating time was 45 min (range, 20-60 min) and the median screening time 2 min (range, 0.3-8.3 min). The majority were for upper tract filling defects. Access and successful diagnosis was achieved in all cases. The major complication rate was 2.6%. The ureteroscope needed repair once during this series. Conclusions: Flexible ureterorenoscopy is an effective diagnostic and therapeutic tool in a select group of patients. It should be considered for ESWL-resistant upper tract stones but the results are poor in stones larger than 20 mm and percutaneous nephrolithotomy may be a better option in these patients.

Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones in the CROES URS Global Study

“…4e20 Only few groups have stratified outcomes by stone size. 5,6,9,20 The size cutoff for a successful single fURS session was 10 mm because beyond this limit SFR decreased to less than 80%. Our study further increases this upper limit to 15 mm without compromising the clearance rate.…”

Clinical effectiveness of the PolyScope™ endoscope system combined with holmium laser lithotripsy in the treatment of upper urinary calculi with a diameter of less than 2 cm

“…In addition, other special cases also exist, such as combined hemorrhagic diathesis, horseshoe kidney, pelvic ectopic kidney, complex renal anatomy, solitary renal calculi, lower calyceal calculi <2 cm and children with renal calculi <1.5 cm. Even renal calculi measuring between 2 and 4 cm have been recommended for treatment using flexible ureteroscopic lithotripsy (3–11). Therefore, the effects of flexible ureteroscopic lithotripsy have been demonstrated to be approximately equal to those of PCNL, but higher than those of ESWL, while the surgical risks of flexible ureteroscopic lithotripsy have been demonstrated to be lower than those of PCNL.…”

Efficacy of flexible fibreoptic ureteroscopy and Holmium laser in retrograde intrarenal surgery for calyceal calculi

“…13 Stents had previously been placed in 53% and dilatation of the ureteric orifice was necessary in 15%. Success was defined as complete stone clearance or good fragmentation to 2 mm or less.…”