NEW YORK (Reuters Health) – With the advent of semi-rigid, fibre-optic based ureteroscopes and deflectable, flexible ureteroscopes, holmium laser lithotripsy can safely and effectively treat renal calculi too large to be managed with less invasive techniques, according to a new study.
Dr. F. G. El-Anany and colleagues, of Assiut University Hospital in Egypt, used endoscopic access and a holmium laser to treat 30 patients with renal stones >2 cm. As reported in the December issue of the British Journal of Urology International, their success rate was 77%.
A semi-rigid ureteropyeloscope was used for the 16 patients with pelvic stones, while the deflectable ureteroscope was used for calyceal stones. With the laser energy setting at a mean of 1.0 J, the urologists began fragmenting the stones inferiorly on one side until a tunnel was formed. The ureteroscope was passed alongside the stone to its superior border, and the remaining fragmentation completed by moving down from the superior part.
If fragments remained, two retrograde ureteric catheters were used for continuous irrigation. After the procedure, ureteric stents were placed for 5 to 7 days, and patients were treated with parenteral and oral antimicrobials for 7 days.
Stones no more than 3 cm required a mean treatment duration of 70 minutes, which was successful in 20 of 23 patients. For the seven patients whose stones were larger than 3 cm, treatment required an average of 135 minutes and was successful in three. Three patients required conversion to a percutaneous technique, and four patients underwent complementary extracorporeal shock wave lithotripsy.
The only complications were hematuria that lasted 2 days in one patient and high-grade fever in two patients.
Br J Urol Int 2001;88:850-853.
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