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Flexible Ureteroscopy and Laser Lithotripsy for Single Intrarenal Stones 2 cm or Greater—Is This the New Frontier?

2008; Lippincott Williams & Wilkins; Volume: 179; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2007.10.083

1527-3792

Alberto Breda, Oreoluwa Ogunyemi, John T. Leppert, John S. Lam, Peter G. Schulam,

Paleopathology and ancient diseases

No AccessJournal of UrologyAdult urology1 Mar 2008Flexible Ureteroscopy and Laser Lithotripsy for Single Intrarenal Stones 2 cm or Greater—Is This the New Frontier? Alberto Breda, Oreoluwa Ogunyemi, John T. Leppert, John S. Lam, and Peter G. Schulam Alberto BredaAlberto Breda More articles by this author , Oreoluwa OgunyemiOreoluwa Ogunyemi More articles by this author , John T. LeppertJohn T. Leppert More articles by this author , John S. LamJohn S. Lam More articles by this author , and Peter G. SchulamPeter G. Schulam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2007.10.083AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Percutaneous nephrolithotomy has been the standard of care for intrarenal calculi greater than 2 cm. Flexible ureteroscopy with holmium laser lithotripsy is a minimally invasive treatment modality that is able to treat large intrarenal calculi with the potential to decrease morbidity, while maintaining a high level of efficacy. Materials and Methods: A total of 15 patients with a single intrarenal calculus 2 cm or greater were treated with retrograde ureteroscopic nephrolithotripsy. Lithotripsy was performed with a 7.2Fr flexible ureteroscope and 200 μ laser fiber. The stone-free rate was defined as the absence of any stones in the kidney or residual stone fragments less than 1 mm, which is too small to be extracted with a basket or a grasper. All patients underwent followup ureteroscopy within 15 days after the last procedure and renal ultrasound 30 days after the last treatment. Results: There were a total of 15 intrarenal calculi 20 to 25 mm (mean 22) in diameter. The mean number of procedures was 2.3 (range 2 to 4). The overall stone-free rate was 93.3%. One patient (6.6%) had a residual 5 mm stone fragment in the lower pole of the kidney, which was followed expectantly for 2 years with no change in size. There were no major complications. There were 3 minor complications (20%), including 1 emergency room visit for fever and pain, and 2 cases of gross hematuria. All cases were performed on an outpatient basis. Conclusions: In select patients with a single intrarenal calculus 2 cm or greater small diameter flexible ureteroscopy with holmium laser lithotripsy may represent an alternative therapy to standard percutaneous nephrolithotomy with acceptable efficacy and low morbidity. References 1 : Percutaneous removal of kidney stones: review of 1,000 cases. J Urol1985; 134: 1077. Link, Google Scholar 2 : Complications in percutaneous nephrolithotomy. Eur Urol2007; 51: 899. Google Scholar 3 : Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol2005; 173: 1991. 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Link, Google Scholar Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California© 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byAssimos D (2019) Re: An Easy Risk Stratification to Recommend the Optimal Patients with 2-3 cm Kidney Stones to Receive Retrograde Intrarenal Surgery or Mini-Percutaneous NephrolithotomyJournal of Urology, VOL. 203, NO. 1, (26-27), Online publication date: 1-Jan-2020.Assimos D (2016) Re: Impact of Retrograde Flexible Ureteroscopy and Intracorporeal Lithotripsy on Kidney Functional OutcomesJournal of Urology, VOL. 195, NO. 5, (1492-1493), Online publication date: 1-May-2016.Skolarikos A, Gross A, Krebs A, Unal D, Bercowsky E, Eltahawy E, Somani B and de la Rosette J (2015) Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones in the CROES URS Global StudyJournal of Urology, VOL. 194, NO. 1, (137-143), Online publication date: 1-Jul-2015.Assimos D (2013) Re: The Impact of RIRS for Asymptomatic Renal Stones in Patients Undergoing Ureteroscopy for a Symptomatic Ureteral StoneJournal of Urology, VOL. 190, NO. 3, (900-901), Online publication date: 1-Sep-2013.Ghani K, Sammon J, Bhojani N, Karakiewicz P, Sun M, Sukumar S, Littleton R, Peabody J, Menon M and Trinh Q (2013) Trends in Percutaneous Nephrolithotomy Use and Outcomes in the United StatesJournal of Urology, VOL. 190, NO. 2, (558-564), Online publication date: 1-Aug-2013.Xue W, Pacik D, Boellaard W, Breda A, Botoca M, Rassweiler J, Van Cleynenbreugel B and de la Rosette J (2012) Management of Single Large Nonstaghorn Renal Stones in the CROES PCNL Global StudyJournal of Urology, VOL. 187, NO. 4, (1293-1297), Online publication date: 1-Apr-2012.Hyams E and Shah O (2009) Percutaneous Nephrostolithotomy Versus Flexible Ureteroscopy/Holmium Laser Lithotripsy: Cost and Outcome AnalysisJournal of Urology, VOL. 182, NO. 3, (1012-1017), Online publication date: 1-Sep-2009.Clayman R (2008) Urolithiasis, Endourology and LaparoscopyJournal of Urology, VOL. 180, NO. 6, (2494-2498), Online publication date: 1-Dec-2008. Volume 179Issue 3March 2008Page: 981-984 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordskidneykidney calculilithotripsylasersureteroscopyMetricsAuthor Information Alberto Breda More articles by this author Oreoluwa Ogunyemi More articles by this author John T. Leppert More articles by this author John S. Lam More articles by this author Peter G. Schulam More articles by this author Expand All Advertisement PDF downloadLoading ...