Residual Fragments Following Ureteroscopic Lithotripsy: Incidence and Predictors on Postoperative Computerized Tomography

Abstract

Of patients who underwent ureteroscopic lithotripsy for calculi 38% had residual fragments by computerized tomography criteria, including more than 50% with stones 1 cm or greater. Such data may guide expectations regarding the success of ureteroscopy in attaining stone-free status.

What is the stone-free rate following flexible ureteroscopy for kidney stones?

“…Since 2005, a total of nine studies have used CT for the assessment of residual frag ments after flexible URS (Table 2). 17,[31][32][33][34][35][36][37][38] In total, 1,361 patients were included, with five studies reporting a mean zero fragment rate of 51% (range 35-60%). 17,31,32,34,38 In the four studies assessing residual fragments ≤2 mm, the mean rate was 77% (range 52-91%).…”

Repeat Surgery After Ureteroscopic Laser Lithotripsy With Attempted Complete Extraction of Fragments: Long-term Follow-up

“…In our present study, we observed that measures of overall stone burden were much better predictors of residual fragments than of repeat surgery. Similarly, Rippel et al, 19 in a large series of patients evaluated by CT after ureteroscopic laser lithotripsy, reported that stone size was the only independent predictor of residual fragments, which were found in 38% of patients. Macejko et al 20 reported that multiplicity of stones and stone location were predictive of residual fragments after ureteroscopy.…”

The glue-clot technique: a new technique description for small calyceal stone fragments removal

“…Residual fragments may produce pain, infection, recurrence, and obstruction either clinically significant or not. These patients could need auxiliary measures, including SWL sessions, double J stent insertion, endoscopic surgical treatment and if not treated could remain in the lower pole and create recurrent stone formation [6][7][8]. For all these reasons, there is a continuous ureteroscopy increase for treating renal stone with an associated low morbidity and excellent stone-free rate [14].…”

“…Residual fragments are known to promote stone recurrence, and this is particularly true for infectious and cystine stones. Also, they could induce renal colic pain, emergency consultations and some cases might need a second procedure [6][7][8]. Therefore, our purpose was to use an autologous venous blood sample to create blood clot into the renal cavities and agglutinate all the fragments, which might allow better stone-free rate and reduce ureterorenal scope passages.…”