Therapeutic Effect of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Renal Calculi_West China Medical Journal

Authors：

 LiangBo , YangPing ,  FengYougang , LiuJun , KangYongming , SunXianyu

Department of Urology, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding author：

FengYougang, Email: uroygfeng@sina.com

Keywords：

Flexible ureteroscopy; Holmium laser; Renal calculi; Lithotripsy

DOI：

10.7507/1002-0179.20160008

Video：

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Objective To evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi. Methods We 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. Results The 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. Conclusion The 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.

Citation： LiangBo, YangPing, FengYougang, LiuJun, KangYongming, SunXianyu. Therapeutic Effect of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Renal Calculi. West China Medical Journal, 2016, 31(1): 29-32. doi: 10.7507/1002-0179.20160008 Copy

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1. 郭峰, 李宗武, 高兴华, 等. 输尿管软镜钬激光碎石术治疗肾结石98例临床观察[J]. 国际泌尿系统杂志, 2013, 33(3):323-325.
2. 曾定胜, 孙先禹, 何俊. 经皮肾镜取石术治疗肾结石(附219例报告)[J]. 华西医学, 2008, 23(6):1280.
3. 段瑞华, 梅力, 张毅. 输尿管软镜钬激光碎石术与经皮肾镜钬激光碎石术治疗肾结石的疗效对比分析[J]. 医药前沿, 2015, 5(29):103-105.
4. Goldsmith ZG, Lipkin ME. When (and how) to surgically treat asymptomatic renal stones[J]. Nat Rev Urol, 2012, 9(6):315-320.
5. 曾国华, 李佳胜, 赵志健, 等. 逆行软性输尿管镜下钬激光碎石术治疗肾结石的有效性与安全性分析[J]. 中华泌尿外科杂志, 2015, 36(6):401-404.
6. Ho C, Hafidzul J, Praveen S, et al. Retrograde intrarenal surgery for renal stones smaller than 2 cm[J]. Singapore Med J, 2010, 51(6): 512-515.
7. Monga M, Beeman WW. Advanced intrarenal ureteroscopic procedures[J]. Urol Clin North Am, 2004, 31(1):129.
8. Wiesenthal JD, Ghiculete D, D'A HRJ, et al. A comparison of treatment modalities for renal calculi between 100 and 300 mm2:are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent[J]. J Endourol, 2011, 25(3):481-485.
9. Goldberg H, Holland R, Tal R, et al. The impact of retrograde intrarenal surgery for asymptomatic renal stones in patients undergoing ureteroscopy for a symptomatic ureteral stone[J]. J Endourol, 2013, 27(8):970-973.
10. Grasso M. Experience with the holmium laser as an endoscopic lithotrite[J]. Urology, 1996, 48(2):199-206.
11. Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm[J]. J Endourol, 2011, 25(7):1131-1135.
12. Johnson GB, Portela D, Grasso M. Advanced ureteroscopy:wireless and sheathless[J]. J Endourol, 2006, 20(8):552-555.
13. 那彦群, 叶章群, 孙光. 中国泌尿外科疾病诊断治疗指南[M]. 北京:人民卫生出版社, 2011:251.
14. 孙颖浩. 泌尿系结石微创治疗的若干问题[J]. 中国微创外科杂志, 2011, 11(1):6-8, 12.
15. Hussain M, Acher P, Penev B, et al. Redefining the limits of flexible ureterorenoscopy[J]. J Endourol, 2011, 25(1):45-49.
16. Preminger GM. Management of lower Pole renal calculi:shock wave lithotripsy versus percutaneous nephrolithotomy versus flexible ureteroscopy[J]. Urol Res, 2006, 34(2):108-111.
17. Weizer AZ, Auge BK, Silverstein AD, et al. Routine postoperative imaging is important after ureteroscopic stone manipulation[J]. J Urol, 2002, 168(1):46-50.
18. 刘齐贵, 张文滔, 段娟, 等. 输尿管软镜结合钬激光治疗肾结石的疗效观察[J]. 中国微创外科杂志, 2012, 12(3):239-241.

West China Medical Journal

Therapeutic Effect of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Renal Calculi

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