泌尿器科・外科
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概要

Semirigid Laser Ureterolithotripsy for Single Large Renal Pelvic Stones

Iraklis C. Mitsogiannis, Athanasios Papatsoris, John Varkarakis, Andreas Skolarikos and Charalampos Deliveliotis

Background and purpose: Large stones located at the renal pelvis are usually managed with Percutaneous Nephrolithotomy (PCNL); however this procedure carries both a substantial morbidity and a considerable risk for complications. Our objective was to assess the safety and efficacy of semirigid ureteroscopy (S-URS) and laser lithotripsy for the treatment of single large (>1.5 cm) pelvic stones.

Patients and methods: Twenty patients (12 women and 8 men, aged 54-72 years) with isolated renal pelvic stone (mean size: 2.1 cm, range: 1.5-3 cm) underwent S-URS under general anesthesia, over a 2-year period (January 2010 to January 2012). Holmium:yttrium-aluminum-garnet (Ho:YAG) laser was used for the stone fragmentation. In all cases the ureters were stented following completion of the operation. Preoperative data, as well as stone-free rate, operative time and associated complications, were retrospectively evaluated.

Results: In 17 patients (18%; 12 women and 5 men) the stones were accessible with S-URS. The mean operative time was 69.4 min (37.2-94.5). There were no major complications, however 2 female patients developed fever due to Urinary Tract Infection (UTI) in the early postoperative period. The stone-free rate (assessed with X-ray) following S-URS was 70.6% on the 1st postoperative day and increased to 82.3% after 1 month. The mean hospitalization period was 1.4 (1.1-4.3) days. Adjuvant Extracorporeal Shockwave Lithotripsy (ESWL) was performed in 3 patients with residual stones (mean number of ESWL sessions: 1.5). Multivariate analysis revealed that only sex (female vs. male) significantly influenced the results, in favor of the females. Conclusions: S-URS is an effective and safe alternative treatment for single large (>1.5 cm) renal pelvic stones, especially in female patients.