Flexible Ureteroscopy with Holmium Laser Lithotripsy: A New Choice for Intrarenal Stone Patients

Abstract

Objective: To evaluate the efficiency and safety of flexible ureteroscopy (FURS) and holmium lithotripsy for intrarenal stones and to stratify the efficiency and safety by stone burdens of ≤20, 20-40, and ≥40 mm. Methods: Five hundred eighty-two patients with intrarenal stones were treated with FURS and holmium lithotripsy at a single department from August 2008 to October 2013. Stone size was evaluated by calculating the cumulative stone diameter of all intrarenal stones, and stone-free status was defined as the absence of any stone or stone fragment <1 mm in the kidney. Results: Data analysis revealed a mean stone burden of 21.8 ± 7.6 mm. The overall primary stone-free rate (SFR) was 65.3%, which increased to 89.0% 6 months after the first surgery. Complications developed in 6.7% of patients. A significant difference was found between lower-calyx stones and other stones (p < 0.001; p = 0.006), while noncalcium stones had a much higher SFR than calcium stones (p < 0.001; p = 0.04). Conclusion: Our study showed that the overall renal SFR with the use of FURS and holmium lithotripsy was satisfactory, with a relatively low complication rate. We believe that FURS with holmium lithotripsy could be a valuable choice for patients with renal stones, especially for patients with a cumulative stone burden ≤40 mm.

Flexible Ureterorenoscopy for Treatment of Kidney Stones: Establishment as Primary Standard Therapy in a Tertiary Stone Center

“…However, the mean operating time was significantly longer in the microperc group (130 vs. 98 min, p = 0.002). Xu et al [23] found that fURS using intrarenal holmium laser lithotripsy may serve as an alternative to mini percutaneous procedures even in larger kidney stones (>2 cm diameter). The estimated pSFR was 65% in their study and increased to 89% 6 months after the first surgery.…”

A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20–30 mm renal stones in obese patients

“…When compared with PCNL, F-URS was widely recognized for its faster post-operative recovery (Xu et al, 2015;Miernik et al, 2012). In our study, the mean post-operative duration of SMP was also longer than the F-RUS, as SMP still made certain wounds to the target kidney and the patients needed more recovery time in bed.…”

“…The application of F-URS has been widespread for the treatment of intra-renal stones due to its many recognized advantages, including: minimal invasiveness, less blood loss and fewer post-operative hospital stays (Doizi et al, 2015;Xu et al, 2015;Wang et al, 2018). However, the high cost of F-URS including operation-related cost for patients and the original purchasing cost, the reprocessing cost and repair fees of the flexible ureteroscope for healthcare institutions limit the use of this procedure worldwide (Schoenthaler et al, 2015).…”

“…With the development of endoscopic technology and the growing use of endoscopic surgery, minimally invasive treatment modalities such as flexible ureteroscopy (F-URS) and percutaneous nephrolithotomy (PCNL) are being widely used for large renal stones and has resulted in acceptable stone free and complication rates. Several studies recommend F-URS for its high success and low complication rates when dealing with renal stones ≥20 mm (Cohen, Cohen & Grasso, 2013;Doizi et al, 2015;Xu et al, 2015). Nevertheless, the use of F-URS in obese patients presents challenges including long-term stone discharge, increased overall cost and requirement of multiple interventions (Sari et al, 2013).…”

Therapeutic use of lasers in urology

“…Lasery mają szczególnie istotne znaczenie w leczeniu kamicy układu moczowego. Dzięki zastosowaniu giętkich endoskopów możliwy jest dostęp do całego górnego odcinka górnych dróg moczowych, zarówno moczowodów, jak i układu kielichowo-miedniczkowego nerki [17]. Miniaturyzacja i elastyczność włókien optycznych powoduje, że lasery są powszechnie stosowane w zabiegach endourologicznych.…”