Outcome of flexible ureteroscopy and holmium laser lithotripsy in the management of renal stones: A two-year retrospective study

Background: Over the decades, the management of renal stones has shifted from the undesirably invasive open nephrolithotomy to the more effective and less invasive approaches with lower morbidity. These less invasive options include extracorporeal shock wave lithotripsy, percutaneous lithotripsy, and flexible ureterorenoscopy (fURS). Aim: This study seeks to evaluate the outcomes of flexible ureterorenoscopy with holmium: yttrium-aluminum-garnet (holmium:YAG) laser lithotripsy for the treatment of renal stones <2.0 cm in our patients. Patients and Methods: Records of 23 patients who underwent flexible ureteroscopy and holmium: YAG laser lithotripsy between October 2020 and September 2022 were reviewed retrospectively. The patients who had the flexible ureteroscopy and laser lithotripsy for renal stones <2.0 cm for various indications were the subjects of this study. All patients had computed tomographic urography preoperatively to locate the stone. Stone-free rate (SFR) was deduced from no stone detected on imaging and resolution of the patient's preoperative complaints related to the renal stones at follow-up. Data on patients' demographics, indication for the surgery, location of the stone, size of the stone, preoperative double J (DJ) placement, postoperative DJ stent placement, intraoperative and postoperative complications, and the SFR were retrieved and subjected to the statistical analysis. Results: A total of 23 patients had fURS and laser lithotripsy during the two-year study period. All the patients had solitary stone in the renal unit operated. The mean stone size for all the patients was 1.3 cm (range: 0.5–1.9 cm). Fifteen (65.2%) patients had DJ stent preoperatively. Postoperative DJ stent was placed in all our patients. Four (17.4%) patients had Grade 1 ureteric injury while none had high Grades (2, 3, and 4) ureteral injuries. Two (9.5%) patients had intraoperative bleeding, 1 (4.8%) had transient haematuria postoperatively while 2 (9.5%) patients had urinary tract infection. The SFR was 91.3% in a single surgery. Two patients (8.7%) had residual fragments in the lower calyx. Conclusion: Flexible ureteroscopy and laser holmium lithotripsy give a satisfactory SFR, with few complications. It is a safe and effective treatment modality for the treatment of stones <2.0 cm in the renal pelvicalyceal system.

[1]  M. Pearle,et al.  International Alliance of Urolithiasis guideline on retrograde intrarenal surgery , 2022, BJU international.

[2]  S. Jeon,et al.  Risk factors of febrile urinary tract infections following retrograde intrarenal surgery for renal stones , 2021, Medicine.

[3]  W. Nahas,et al.  Treatment of renal lower pole stones: an update , 2021, International braz j urol : official journal of the Brazilian Society of Urology.

[4]  Ø. Ulvik,et al.  What do we mean by «stone free», and how accurate are urologists in predicting stone free status following ureteroscopy?. , 2020, Journal of endourology.

[5]  Victor K. F. Wong,et al.  Controversies associated with ureteral access sheath placement during ureteroscopy , 2020, Investigative and clinical urology.

[6]  S. Nakada,et al.  Influence of Lower Pole Infundibulopelvic Angle on Success of Retrograde Flexible Ureteroscopy and Laser Lithotripsy for the Treatment of Renal Stones. , 2020, Journal of endourology.

[7]  J. Ouyang,et al.  Risk Factors of Infectious Complications following Ureteroscopy: A Systematic Review and Meta-Analysis , 2019, Urologia Internationalis.

[8]  B. Somani,et al.  Mortality from kidney stone disease (KSD) as reported in the literature over the last two decades: a systematic review , 2018, World Journal of Urology.

[9]  Hisham Alazaby,et al.  Outcome of retrograde flexible ureterorenoscopy and laser lithotripsy for treatment of multiple renal stones , 2018, African Journal of Urology.

[10]  B. Van Cleynenbreugel,et al.  Retrograde intrarenal surgery for renal stones - Part 1. , 2017, Turkish journal of urology.

[11]  J. J. de la Rosette,et al.  Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study , 2016, World Journal of Urology.

[12]  N. Cera,et al.  Infective complications after retrograde intrarenal surgery: a new standardized classification system , 2016, International Urology and Nephrology.

[13]  M. Araki,et al.  Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients. , 2016, Acta medica Okayama.

[14]  T. Knoll,et al.  International Collaboration in Endourology: Multicenter Evaluation of Prestenting for Ureterorenoscopy. , 2016, Journal of endourology.

[15]  T. Knoll,et al.  EAU Guidelines on Interventional Treatment for Urolithiasis. , 2016, European Urology.

[16]  H. Shafi,et al.  An overview of treatment options for urinary stones , 2016, Caspian journal of internal medicine.

[17]  C. Liang,et al.  Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study. , 2015, International journal of clinical and experimental medicine.

[18]  Masayuki Takahashi,et al.  Complications of Flexible Ureteroscopic Treatment for Renal and Ureteral Calculi during the Learning Curve , 2015, Urologia Internationalis.

[19]  M. Yao,et al.  Development and internal validation of a nomogram for predicting stone‐free status after flexible ureteroscopy for renal stones , 2015, BJU international.

[20]  TraxerOlivier,et al.  The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: Indications, Complications, and Outcomes in 11,885 Patients , 2014 .

[21]  O. Traxer,et al.  Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. , 2013, The Journal of urology.

[22]  M. Fujisawa,et al.  How long should double J stent be kept in after ureteroscopic lithotripsy? , 2012, Urological Research.

[23]  N. Buchholz,et al.  The role of open stone surgery , 2012, Arab journal of urology.

[24]  F. Hammad,et al.  The effect of fat and nonfat components of the skin-to-stone distance on shockwave lithotripsy outcome. , 2010, Journal of endourology.

[25]  R. Munver,et al.  Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. , 2010, Journal of endourology.

[26]  Razvan Multescu,et al.  Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach. , 2008, Journal of endourology.

[27]  J. Lam,et al.  Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater--is this the new frontier? , 2008, The Journal of urology.

[28]  J. R. Colombo,et al.  Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi. , 2008, International braz j urol : official journal of the Brazilian Society of Urology.

[29]  S. Nakada,et al.  Treatment selection and outcomes: renal calculi. , 2007, The Urologic clinics of North America.

[30]  Maurice Stephan Michel,et al.  Complications in percutaneous nephrolithotomy. , 2007, European urology.

[31]  Joel M. H. Teichman,et al.  Lasers in clinical urology: state of the art and new horizons , 2007, World Journal of Urology.

[32]  R. Leveillee,et al.  Intracorporeal lithotripsy: which modality is best? , 2003, Current opinion in urology.

[33]  M. Sofer,et al.  Flexible ureteroscopy and lithotripsy with the Holmium: YAG laser. , 2000, The Canadian journal of urology.

[34]  F. Kim,et al.  The S.T.O.N.E. Score: a new assessment tool to predict stone free rates in ureteroscopy from pre-operative radiological features. , 2014, International braz j urol : official journal of the Brazilian Society of Urology.

[35]  B. Jeong,et al.  www.kjurology.org DOI:10.4111/kju.2010.51.11.777 Endourology/Urolithiasis Treatment Outcomes of Retrograde Intrarenal Surgery for Renal Stones and Predictive Factors of Stone-Free , 2010 .

[36]  R. Clayman,et al.  Comparison of Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy for the Treatment of Renal Calculi in Lower Pole Calices , 1989 .

[37]  G. Vallancien,et al.  Outpatient extracorporeal lithotripsy of kidney stones: 1,200 treatments. , 1988, European urology.