ObjectiveTo evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi. MethodsWe retrospectively analyzed the data of 78 patients from August 2012 to February 2014 who underwent flexible ureteroscopic holmium laser lithotripsy in our hospital. Among them, calculi were located at the upper or middle calyx in 41 patients, at the lower calyx in 27, at the renal pelvis in 6, and at multiple calyxes in 4. The diameter of the stones ranged from 0.8 to 2.0 cm with a mean of 1.4 cm. The stones were fragmentized by using 200 μm holmium laser fiber. A follow-up by renal CT scan was done 4 weeks after the procedure to evaluate the rate of the stone clearance. ResultsThe calculi were detected in 76 patients (97.4%, 76/78). The success rate in one-session procedure was 94.9% (74/78). After 4 weeks, the total stone-free rate was 97.4% (74/76). The mean operative time was 30 minutes (20-55 minutes). The mean hospital stay of the patients was 3 days (2-6 days). Two cases were found to have lower back pain combined with fever and cured by anti-inflammatory treatment. Naked eye hematuria disappeared in our cases after operation for 1 to 2 days. Seventy-four cases were followed up from 4 to 16 months with a median time of 8 months and no recurrence was detected. ConclusionThe flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi, with a high discovery rate of stones, high success rate, high evacuation rate, few severe complications, short hospital stay and sustainable treatment.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of longer than 2 cm in diameter. MethodsFrom August 2012 to July 2014, 15 selected patients with renal calculi of longer than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. Preoperative indwelling ureteral stent was performed for 1-2 weeks, and super smooth guidewire was inserted after checking and dilation of the ureter was performed with F8.0/9.8 rigid ureterosope. Flexible ureteroscope sheath was inserted through guidewire. Ureterosope was followed by flexible ureteroscope sheath. Larger stone fragments were removed by basket. ResultsThe success rate of ureteroscopic insertion was 100% and no severe intraoperative complications occurred. The operation time ranged from 50 to 125 minutes averaging 75. No ureteral perforations or pyonephrosis or acute renal insufficiency occurred. Four patients had high fever after operation and improved after positive anti-infection treatment. After 2 days, the stone-free rate was 73.3% (11/15) by reviewing KUB. The follow-up of 4 weeks showed the stone-free rate was 86.7% (13/15). One case of stone fragments retained in the middle and lower ureter and the fragments were taken out by ureteroscopic lithotripsy. The other case of renal residual calculi was operated by flexible ureteroscope holmium laser lithotripsy in two stage. ConclusionFlexible ureteroscopic lithotripsy is a favorable option for patients with renal stones of longer than 2 cm in diameter, especially for recurrent renal calculi.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for patients with renal calculi of more than 2 cm in diameter. MethodsThe Clinical data of 37 patients with renal calculi of more than 2 cm in diameter treated with holmium laser lithotripsy through flexible ureteroscope between December 2012 and March 2015 were retrospectively analyzed. In this group, stone diameter was between 2.0 cm and 3.5 cm, including 22 cases of single stone and 15 cases of multiple stones. Preoperative ureteral stents were indwelt in all the patients for 1-2 weeks. After dilation of the ureter with F8/9.8 rigid ureteroscope, the ureteral access sheath for flexible ureteroscope was inserted to the target ureter followed by flexible ureteroscope. Stones were fragmentized by holmium laser and the power was not more than 30 W (1.0-1.5 J/15-20 Hz). ResultsThe success rate of ureteroscopic insertion was 100% (37/37). The operation time ranged from 40 to 185 minutes with a mean of 73 minutes. After the operation, one patient had sepsis, and was cured after positive anti-infection treatment. No other serious complications occurred. Four and 8 weeks after surgery, the free-stone rate was 73.0% (27/37) and 86.5% (32/37) respectively. ConclusionThe flexible ureteroscopic lithotripsy is advantageous in less trauma, fewer complications, quick recovery and higher free-stone rate. It can be used to treat renal calculi of over 2 cm in diameter selectively.