Safety and Efficacy of Flexible Ureterorenoscopy and Holmium:YAG Lithotripsy for Intrarenal Stones in Anticoagulated Cases

Abstract

When necessary, ureterorenoscopy and Ho:YAG lithotripsy can be performed safely and efficaciously for renal calculi in patients on anticoagulation therapy without the need for perioperative manipulation.

Ureteroscopy in patients with coagulopathies is associated with lower stone-free rate and increased risk of clinically significant hematuria

“…This is because endoscopic procedures with (17). Thus, URS and HLL may be the only option for these patients with coagulopathies since they are often poor candidates for SWL or PCNL due to hemorrhagic and thromboembolic complications (10,13). In the present study, 6 out of 9 patients (patients 1, 2, 4, 5, 8, 9) in Group I undergoing URS and laser lithotripsy had significant stone burden (Table-1).…”

“…Another patient (4%) developed DVT with pulmonary embolism on POD 4 requiring IVC filter since he had developed hemorrhage when anticoagulation was initiated (2). Furthermore, the expense of bridging therapy (with low molecular weight heparin or intravenous heparin) is considerable (10). Therefore, the present study expands the indications for URS in patients with coagulopathies to those who are traditionally treated with PCNL with reversal of their anti-coagulation.…”

“…However, despite pre-operative correction and apparently normal clotting parameters, patients with coagulopathy have a higher rate of complications and lower efficacy of SWL (12). The safety of URS and holmium laser lithotripsy in patients with coagulopathies without correction of the abnormality have been reported in 3 retrospective studies (10,13,14). Therefore, the aim of the present study was to expand the indications for URS in patients with coagulopathies and compare their outcome with concurrent patients with normal clotting parameters.…”

“…Therefore, peri-operative maintenance on anti-platelet agents is recommended for low-hemorrhagic risk procedures after drug-eluting stents (9). Extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), laparoscopic or open stone surgery are contraindicated in patients with coagulopathies (10). Traditionally, bleeding diathesis is corrected and the anticoagulation therapy is withheld prior to any urological intervention to minimize surgical hemorrhage (11).…”

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

“…Turna et al demonstrated the safety of this procedure in anticoagulated cases. 20 Our study, though limited, proved the effectiveness of flexible ureteroscopy with Holmium laser for managing calyceal and diverticular calculi. As with any new procedure there was a learning curve, but successfully cleared calculi in 70.55% cases after one or two sessions without any residue.…”