Abstract
This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6–1.2 J, 20–30 Hz) lithotripsy via a fiber with a 200-μm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7 mm and 181.9 ± 172.2 mm2, respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6 min, and the mean hospital stay was 5.3 ± 2.4 days. The mean decrease in the hemoglobin level was 7.3 ± 6.5 g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.
Similar content being viewed by others
References
Gu Z, Qi J, Shen H, Liu J, Chen J (2010) Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi. Laser Med Sci 25:577–80
Kukreja R, Desai M, Patel S, Bapat S, Desai M (2004) Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 18:715–722
Muslumanoglu AY, Tefekli A, Karadag MA, Tok A, Sari E, Berberoglu Y (2006) Impact of percutaneous access point number and location on complication and success rates in percutaneous nephrolithotomy. Urol Int 77:340–6
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51:1688–93
El-Nahas AR, Ibrahim HM, Youssef RF, Sheir KZ (2012) Flexible ureterorenoscopy versus extracorporeal shockwave lithotripsy for treatment of lower pole stones of 10–20 mm. BJU Int 110:898–902
Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T (2011) Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Uro Res 39:185–8
Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK (2012) Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol 26:1257–63
Golijanin D, Katz R, Verstandig A, Sasson T, Landau EH, Meretyk S (1998) The supracostal percutaneous nephrostomy for treatment of staghorn and complex kidney stones. J Endourol 12:403–5
Fayad AS, Elsheikh MG, Mosharafa A, El-Sergany R, Abdel-Rassoul MA, Elshenofy A et al (2014) Effect of multiple access tracts during percutaneous nephrolithotomy on renal function: evaluation of risk factors for renal function deterioration. J Endourol 28:775–9
Akman T, Sari E, Binbay M, Yuruk E, Tepeler A, Kaba M et al (2010) Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. J Endourol 24:955–60
Zhong W, Zeng G, Wu W, Chen W, Wu K (2011) Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res 39:117–22
Li LY, Gao X, Yang M, Li JF, Zhang HB, Xu WF et al (2010) Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study. Urology 75:56–61
Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M (2001) Guidelines on urolithiasis. Eur Urol 40:362–71
Wiesenthal JD, Ghiculete D, D’A Honey RJ, Pace KT (2011) A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent? J Endourol 25:481–5
Bozkurt OF, Resorlu B, Yildiz Y, Can CE, Unsal A (2011) Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol 25:1131–5
Kourambas J, Byrne RR, Preminger GM (2001) Does a ureteral access sheath facilitate ureteroscopy? J Urol 165:789–93
Kesler SS, Pierre SA, Brison DI, Preminger GM, Munver R (2008) Use of the escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study. J Endourol 22:1213–7
Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2013) Guidelines on urolithiasis. Eur Assoc Urol 37:339–344
Takazawa R, Kitayama S, Tsujii T (2012) Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater. Int J Urol 19:264–7
de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol 25:11–7
Akman T, Binbay M, Ozgor F, Ugurlu M, Tekinarslan E, Kezer C, Aslan R, Muslumanoglu AY (2012) Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2–4 cm stones: a matched-pair analysis. BJU Int 109:1384–9
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standard
This article does not involve ethical issues.
Role of funding source
Not applicable.
Additional information
L. Chen and M.-L. Sha contributed equally to this work.
Rights and permissions
About this article
Cite this article
Chen, L., Sha, ML., Li, D. et al. Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy. Lasers Med Sci 32, 649–654 (2017). https://doi.org/10.1007/s10103-017-2162-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-017-2162-5