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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12.	Johnson GB, Portela D, Grasso M. Advanced ureteroscopy:wireless and sheathless[J]. J Endourol, 2006, 20(8):552-555.
13.	那彥群, 葉章群, 孫光. 中國泌尿外科疾病診斷治療指南[M]. 北京:人民衛生出版社, 2011:251.
14.	孫穎浩. 泌尿系結石微創治療的若干問題[J]. 中國微創外科雜志, 2011, 11(1):6-8, 12.
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18.	劉齊貴, 張文滔, 段娟, 等. 輸尿管軟鏡結合鈥激光治療腎結石的療效觀察[J]. 中國微創外科雜志, 2012, 12(3):239-241.

1. 郭峰, 李宗武, 高興華, 等. 輸尿管軟鏡鈥激光碎石術治療腎結石98例臨床觀察[J]. 國際泌尿系統雜志, 2013, 33(3):323-325.
2. 曾定勝, 孫先禹, 何俊. 經皮腎鏡取石術治療腎結石(附219例報告)[J]. 華西醫學, 2008, 23(6):1280.
3. 段瑞華, 梅力, 張毅. 輸尿管軟鏡鈥激光碎石術與經皮腎鏡鈥激光碎石術治療腎結石的療效對比分析[J]. 醫藥前沿, 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. 曾國華, 李佳勝, 趙志健, 等. 逆行軟性輸尿管鏡下鈥激光碎石術治療腎結石的有效性與安全性分析[J]. 中華泌尿外科雜志, 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. 那彥群, 葉章群, 孫光. 中國泌尿外科疾病診斷治療指南[M]. 北京:人民衛生出版社, 2011:251.
14. 孫穎浩. 泌尿系結石微創治療的若干問題[J]. 中國微創外科雜志, 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. 劉齊貴, 張文滔, 段娟, 等. 輸尿管軟鏡結合鈥激光治療腎結石的療效觀察[J]. 中國微創外科雜志, 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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