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Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi.
Int Braz J Urol. 2008 Mar-Apr; 34(2):143-9; discussion 149-50.IB

Abstract

OBJECTIVE

To assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients.

MATERIALS AND METHODS

Between February 2004 and September 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. Renal stones were associated with collecting system obstruction in 15 (34%) patients, failed extracorporeal shock-wave lithotripsy (SWL) occurred in 14 (32%) patients, unilateral multiple stones in 18 (41%) patients, and multiple bilateral stones in 3 (7%). In 29 (66%) patients, the stone was located in the inferior calyx. Perioperative and financial outcomes were also evaluated.

RESULTS

50 procedures were performed in 44 patients. The mean stone burden on preoperative CT scan was 11.5 +/- 5.8 mm. The mean operative time was 61.3 +/- 29.4 min. The stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. Therapeutic success occurred in 92% and 93% of patients with lower pole stones and SWL failure, respectively. Treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007), but not associated with inferior calyx location (p = 0.09). Surgical disposables were responsible for 78% of overall costs.

CONCLUSION

Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure.

Authors+Show Affiliations

Division of Urology, University of Sao Paulo, USP, Sao Paulo, Brazil. mcocuzza@uol.com.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18462511

Citation

Cocuzza, Marcello, et al. "Outcomes of Flexible Ureteroscopic Lithotripsy With Holmium Laser for Upper Urinary Tract Calculi." International Braz J Urol : Official Journal of the Brazilian Society of Urology, vol. 34, no. 2, 2008, pp. 143-9; discussion 149-50.
Cocuzza M, Colombo JR, Cocuzza AL, et al. Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi. Int Braz J Urol. 2008;34(2):143-9; discussion 149-50.
Cocuzza, M., Colombo, J. R., Cocuzza, A. L., Mascarenhas, F., Vicentini, F., Mazzucchi, E., & Srougi, M. (2008). Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi. International Braz J Urol : Official Journal of the Brazilian Society of Urology, 34(2), 143-9; discussion 149-50.
Cocuzza M, et al. Outcomes of Flexible Ureteroscopic Lithotripsy With Holmium Laser for Upper Urinary Tract Calculi. Int Braz J Urol. 2008 Mar-Apr;34(2):143-9; discussion 149-50. PubMed PMID: 18462511.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi. AU - Cocuzza,Marcello, AU - Colombo,Jose R,Jr AU - Cocuzza,Antonio L, AU - Mascarenhas,Frederico, AU - Vicentini,Fabio, AU - Mazzucchi,Eduardo, AU - Srougi,Miguel, PY - 2007/07/04/accepted PY - 2008/5/9/pubmed PY - 2009/8/22/medline PY - 2008/5/9/entrez SP - 143-9; discussion 149-50 JF - International braz j urol : official journal of the Brazilian Society of Urology JO - Int Braz J Urol VL - 34 IS - 2 N2 - OBJECTIVE: To assess the perioperative and financial outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper tract calculi in 44 patients. MATERIALS AND METHODS: Between February 2004 and September 2006, 44 patients treated for upper tract stone with flexible ureteroscopic lithotripsy were evaluated. Renal stones were associated with collecting system obstruction in 15 (34%) patients, failed extracorporeal shock-wave lithotripsy (SWL) occurred in 14 (32%) patients, unilateral multiple stones in 18 (41%) patients, and multiple bilateral stones in 3 (7%). In 29 (66%) patients, the stone was located in the inferior calyx. Perioperative and financial outcomes were also evaluated. RESULTS: 50 procedures were performed in 44 patients. The mean stone burden on preoperative CT scan was 11.5 +/- 5.8 mm. The mean operative time was 61.3 +/- 29.4 min. The stone free rate was 93.1% after one procedure and 97.7% after a second procedure, with overall complication rate of 8%. Therapeutic success occurred in 92% and 93% of patients with lower pole stones and SWL failure, respectively. Treatment failure of a single session was associated with presence of a stone size larger than 15 mm (p = 0.007), but not associated with inferior calyx location (p = 0.09). Surgical disposables were responsible for 78% of overall costs. CONCLUSION: Flexible ureteroscopy using holmium laser is a safe and effective option for the treatment of upper urinary tract calculi. In addition, it can be considered an attractive option as salvage therapy after SWL failure or kidney calculi associated with ureteral stones. Stone size larger than 15 mm is associated with single session treatment failure. SN - 1677-5538 UR - https://www.unboundmedicine.com/medline/citation/18462511/Outcomes_of_flexible_ureteroscopic_lithotripsy_with_holmium_laser_for_upper_urinary_tract_calculi_ L2 - http://www.brazjurol.com.br/march_april_2008/Cocuzza_ing_143_150.htm DB - PRIME DP - Unbound Medicine ER -