Curative Effect of Holmium Laser Lithotripsy through Flexible Ureteroscope for Renal Calculi of over 2 cm in Diameter_West China Medical Journal

Authors：

 WangLiang , LiuJiwen , DiaoSijun , HuangYike , YangHang , LiuXiangdan , CaoWenfeng , LiShadan , ChenWeiguo , LiXiaowei , YangWei , ZhouTingting

Department of Urology, General Hospital of Chengdu Military Region of PLA, Chengdu, Sichuan 610083, P. R. China;

Corresponding author：

Keywords：

Renal calculi; Flexible ureteroscope; Holmium laser

DOI：

10.7507/1002-0179.201600498

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Objective To evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for patients with renal calculi of more than 2 cm in diameter. Methods The 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). Results The 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. Conclusion The 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.

Citation： WangLiang, LiuJiwen, DiaoSijun, HuangYike, YangHang, LiuXiangdan, CaoWenfeng, LiShadan, ChenWeiguo, LiXiaowei, YangWei, ZhouTingting. Curative Effect of Holmium Laser Lithotripsy through Flexible Ureteroscope for Renal Calculi of over 2 cm in Diameter. West China Medical Journal, 2016, 31(11): 1814-1817. doi: 10.7507/1002-0179.201600498 Copy

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1. 那彦群. 中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社, 2014:137-147.
2. European Association of Urology. Guidelines on Urolithiasis (revised 2015)[EB/OL].(2015-03-06)[2015-08-14].http://uroweb.org/wp-content/uploads/22-Urolithiasis-LR-full.pdf.
3. Hyams ES, Munver R, Bird VG, et al. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm:a multi-institional experience[J].J Endourol, 2010, 24(10):1583-1588.
4. 刘建河, 潘春武, 李瑞鹏, 等. 输尿管软镜下钬激光碎石处理直径>2 cm肾结石[J].中国微创外科杂志, 2014, 14(2):132-137.
5. Aboumarzouk OM, Monga M, Kata SG, et al. Flexible ureteroscopy and laser lithotripsy for stones> 2 cm:a systematic review and meta-analysis[J].J Endourol, 2012, 26(10):1257-1263.
6. Semins MJ, Trock BJ, Matlagabr BR. The safety of ureteroscopy during pregnancy:a systematic review and meta-analysis[J].J Urol, 2009, 181(1):139-143.
7. 程跃, 施小东, 胡嘉盛, 等. 电子输尿管软镜下钬激光碎石术[J].中国内镜杂志, 2011, 17(2):212-214, 217.
8. Auge BK, Pietrow PK, Lallas CD, et al. Ureteral access sheath provides protection against elevated renal pressure during routine flexible ureteroscopic stone manipulation[J].J Endourol, 2004, 18(1):33-36.
9. 田雨, 卢剑, 肖春雷, 等. 输尿管软镜在泌尿外科疾病诊断及治疗中的应用[J].中国微创外科杂志, 2013, 13(4):322-326.
10. Osman Y, Harraz AM, El-Nahas AR, et al. Clinically insignificant residual fragments:an acceptable term in the computed tomogyaphy era?[J].Urology, 2013, 81(4):723-726.
11. 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.
12. Geavlete P, Multescu R, Geavlete B. Influence of pyelocaliceal anatomy on the success of flexible ureteroscopic approach[J].J Endourol, 2008, 22(10):2235-2239.
13. 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.
14. 孙颖浩, 戚晓升, 王林辉, 等. 输尿管软镜下钬激光碎石术治疗肾结石(附51例报告)[J].中华泌尿外科杂志, 2002, 23(11):681-682.
15. 郭应禄. 泌尿外科内镜诊断治疗学[M].北京:北京大学医学出版社, 2004:116-118.
16. 刘齐贵, 麻伟青, 张文滔, 等. 输尿管软镜技术的临床应用[J].中国误诊学杂志, 2011, 11(13):3053-3055.

West China Medical Journal

Curative Effect of Holmium Laser Lithotripsy through Flexible Ureteroscope for Renal Calculi of over 2 cm in Diameter

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