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Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience.
J Endourol. 2010 Oct; 24(10):1583-8.JE

Abstract

BACKGROUND AND PURPOSE

Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)/holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS/laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS/laser lithotripsy for renal stone burdens that measure 2 to 3 cm.

PATIENTS AND METHODS

Patients who underwent URS/holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS/laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and <4 mm residual stone burden on postoperative imaging.

RESULTS

One hundred and twenty patients underwent URS/holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg/m². Indications for URS/laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month follow-up was 3/120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm.

CONCLUSIONS

We demonstrate that single-stage URS/holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS/laser lithotripsy is a viable treatment option for selected patients.

Authors+Show Affiliations

Department of Urology, New York University School of Medicine, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

20629566

Citation

Hyams, Elias S., et al. "Flexible Ureterorenoscopy and Holmium Laser Lithotripsy for the Management of Renal Stone Burdens That Measure 2 to 3 Cm: a Multi-institutional Experience." Journal of Endourology, vol. 24, no. 10, 2010, pp. 1583-8.
Hyams ES, Munver R, Bird VG, et al. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol. 2010;24(10):1583-8.
Hyams, E. S., Munver, R., Bird, V. G., Uberoi, J., & Shah, O. (2010). Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. Journal of Endourology, 24(10), 1583-8. https://doi.org/10.1089/end.2009.0629
Hyams ES, et al. Flexible Ureterorenoscopy and Holmium Laser Lithotripsy for the Management of Renal Stone Burdens That Measure 2 to 3 Cm: a Multi-institutional Experience. J Endourol. 2010;24(10):1583-8. PubMed PMID: 20629566.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. AU - Hyams,Elias S, AU - Munver,Ravi, AU - Bird,Vincent G, AU - Uberoi,Jayant, AU - Shah,Ojas, PY - 2010/7/16/entrez PY - 2010/7/16/pubmed PY - 2011/2/2/medline SP - 1583 EP - 8 JF - Journal of endourology JO - J. Endourol. VL - 24 IS - 10 N2 - BACKGROUND AND PURPOSE: Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)/holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS/laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS/laser lithotripsy for renal stone burdens that measure 2 to 3 cm. PATIENTS AND METHODS: Patients who underwent URS/holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS/laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and <4 mm residual stone burden on postoperative imaging. RESULTS: One hundred and twenty patients underwent URS/holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg/m². Indications for URS/laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month follow-up was 3/120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm. CONCLUSIONS: We demonstrate that single-stage URS/holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS/laser lithotripsy is a viable treatment option for selected patients. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/20629566/Flexible_ureterorenoscopy_and_holmium_laser_lithotripsy_for_the_management_of_renal_stone_burdens_that_measure_2_to_3_cm:_a_multi_institutional_experience_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2009.0629?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -