Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis.
ABSTRACT To determine whether stone location affects the stone-free rates of endoscopic lithotripsy for nephrolithiasis.
From January 2002 to August 2006, 245 patients with 272 stones, ranging from 4 to 20 mm in size, underwent ureteroscopy (URS) with laser lithotripsy at West Virginia University Hospital. The patients were followed up postoperatively with noncontrast spiral computed tomography, abdominal plain radiography, renal ultrasonography, or retrograde pyelography. Patients were considered to have been treated successfully if they had no residual stones. All pediatric patients were excluded, as were all patients with stones greater than 2 cm. Also, patients who had undergone previous shock wave lithotripsy, percutaneous nephrolithotripsy, or URS by an outside urologist were excluded.
A total of 86 kidney stones were treated with URS and laser lithotripsy. Of these, 81 (94.2%) were successfully treated. Five patients (5.8%) had persistent stones. All 18 upper pole stones (100%) were cleared, 23 (95.8%) of 24 middle pole stones were cleared, and 40 (90.9%) of 44 lower pole stones were cleared (P = 0.338).
URS is an important tool for treating nephroureterolithiasis with excellent success rates and minimal morbidity. The results of our study have shown that stone location does not significantly affect stone clearance rates when performing endoscopic lithotripsy for intrarenal calculi.
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ABSTRACT: Contemporary treatment of lower pole renal calculi includes extracorporeal shock wave lithotripsy, percutaneous nephrostolithotomy and retrograde ureteropyeloscopy. Success rates for shock wave lithotripsy are reduced in this setting, especially for stones greater than 1 cm. and/or in patients with anatomical variants. Percutaneous treatment, although effective, subjects the patient to increased morbidity. We studied the safety and efficacy of retrograde ureteroscopic treatment of lower pole intrarenal calculi. We evaluated 90 stone burdens localized to the lower pole and treated with a small diameter, actively deflectable, flexible ureteropyeloscope and a 200 micron holmium laser fiber. Stone burdens were classified as group 1--10 or less, group 2--11 to 20 and group 3--greater than 20 mm. in largest diameter. Patients with calculi less than 2.5 cm. were treated as outpatients unless concurrent medical conditions required hospitalization. Larger stones and partial staghorn calculi (group 3) frequently required 2-stage endoscopic procedures with retrograde intrarenal irrigation for 36 hours to clear debris. An acceptable immediate surgical outcome was defined as complete fragmentation reducing the stone burden to dust and 2 mm. or less fragments. Success was defined as clear imaging (that is stone-free) on renal sonography with minimum 3-month followup. Extreme anatomical variants, including a long infundibulum, acute infundibulopelvic angle and a dilated collecting system, were noted and correlated with surgical failures. Endoscopic access and complete stone fragmentation were achieved in 94, 95 and 45% of groups 1, 2 and 3, respectively. After a second treatment the success rate increased to 82% in group 3, with an overall rate of 91%. Of the 19 surgical failures 8 were secondary to inability to access the lower pole and 11 were secondary to inability to render the patient stone-free. In 2 of the 19 cases infundibular strictures hindered ureteroscopic access. In addition, of the anatomical variants a long lower pole infundibulum was the most statistically significant predictor of failure. Mean operative time ranged from 38 minutes for small to 126 for the largest calculi. There were no major complications. Overall stone-free rates with minimum 3-month followup were 82, 71 and 65% in groups 1, 2 and 3, respectively, and 88, 77 and 81%, respectively, in patients with an acceptable initial surgical outcome (that is excluding those with access failures from analysis). Retrograde ureteropyeloscopy is a safe and effective surgical treatment for lower pole intrarenal calculi.The Journal of Urology 01/2000; 162(6):1904-8. · 3.70 Impact Factor
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ABSTRACT: Recent advances in the design of flexible ureteroscopes have resulted in smaller caliber instruments. We review our experience with the smaller flexible ureteroscopes, and compare the efficacy and efficiency of the newer 7.5F to the standard 9.3F flexible instruments. Between January 1991 and 1995, 69 male and 41 female patients (mean age 57 years, range 16 to 91) underwent 116 retrograde flexible ureteroscopic procedures for a variety of diagnostic and therapeutic indications. A 9.3F ureteroscope (group 1) was used in 71 patients and a 7.5F instrument (group 2) was used in 39. Patients in group 2 received sedation analgesia significantly more often than those in group 1 (56 versus 35%, p = 0.04). Active dilation of the ureteral orifice was required less often in group 2 (22.5%) than in group 1 (58%, p < or = 0.05). The total success rate for stone management, and diagnosis and/or treatment of an upper urinary tract lesion was 98.3 and 100%, respectively, in group 1, and 90 and 100%, respectively, in group 2 (p = 0.17). Of the 71 patients in group 1, 17 (24%) were treated on an outpatient basis, compared to 14 of 39 (49%) in group 2 (p = 0.16). No intraoperative or postoperative major complications were encountered in either group. Group 2 required less postoperative analgesia (p = 0.05). No ureteral stricture occurred in either group at an average followup of 9.5 months postoperatively (range 2 to 35). For ureteral and renal pathological conditions the 7.5F ureteroscope is as effective as the 9.3F instrument diagnostically and therapeutically. The 7.5F ureteroscope usually can be used with sedation analgesia. Also, the smaller 7.5F ureteroscope is associated with less need for active ureteral dilation, minimal postoperative discomfort and a brief hospital stay.The Journal of Urology 07/1997; 157(6):2074-80. · 3.70 Impact Factor
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ABSTRACT: To evaluate our experience in treating 155 patients with upper urinary tract calculi ureteroscopically. The treatment of urinary calculi has remained the most frequent application of ureteroscopy. Miniaturization of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract. Ureteroscopic stone treatment was attempted in 155 patients with upper urinary tract calculi between November 1995 and March 1997. Fifty-nine (38.1%) patients had renal calculi, 82 (52.9%) ureteral, and 14 (9%) had both renal and ureteral calculi. Both semirigid and flexible ureteroscopes were used for treatment (rigid alone in 21 [13.5%], flexible in 64 [41.3%], and both rigid and flexible in 70 [45.2%] patients). Lithotripsy was required in 122 (79%) of the patients. The holmium:yttrium-aluminum-garnet laser was used in 113 (92.6%) of these patients. All patients with ureteral calculi (29 proximal, 19 mid, and 34 distal) were successfully cleared after one endoscopic procedure except for 1 patient with a proximal ureteral calculus who had a 4-mm residual fragment in the kidney. Of the 59 patients with renal calculi, 47 (79.7%) were totally clear of stones 1 month after treatment. The remaining 12 (20.3%) patients had evidence of residual calculi 3 to 4 mm or less in diameter. In patients with combined renal and ureteral calculi, 1 1 of 14 (78.6%) were rendered stone free. The remaining 3 (21.4%) patients had evidence of residual calculi 4 mm in diameter. Overall, 95% of the patients were treated in an outpatient setting. Morbidity was low, with no evidence of stricture. Ureteroscopy and laser lithotripsy in experienced hands are a safe and reliable method for the treatment of ureteral and even intrarenal calculi.Urology 02/1999; 53(1):25-31. · 2.42 Impact Factor