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Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.
J Endourol. 2018 07; 32(7):603-607.JE

Abstract

INTRODUCTION

Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports.

METHODS

A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated.

RESULTS

We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor.

CONCLUSIONS

Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Authors+Show Affiliations

1 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada .2 Department of Urology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania.3 Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital , New York, New York.2 Department of Urology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania.2 Department of Urology, Thomas Jefferson University Hospital , Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29732915

Citation

Scotland, Kymora B., et al. "Retrograde Ureteroscopic Management of Large Renal Calculi: a Single Institutional Experience and Concise Literature Review." Journal of Endourology, vol. 32, no. 7, 2018, pp. 603-607.
Scotland KB, Rudnick B, Healy KA, et al. Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review. J Endourol. 2018;32(7):603-607.
Scotland, K. B., Rudnick, B., Healy, K. A., Hubosky, S. G., & Bagley, D. H. (2018). Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review. Journal of Endourology, 32(7), 603-607. https://doi.org/10.1089/end.2018.0069
Scotland KB, et al. Retrograde Ureteroscopic Management of Large Renal Calculi: a Single Institutional Experience and Concise Literature Review. J Endourol. 2018;32(7):603-607. PubMed PMID: 29732915.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review. AU - Scotland,Kymora B, AU - Rudnick,Benjamin, AU - Healy,Kelly A, AU - Hubosky,Scott G, AU - Bagley,Demetrius H, Y1 - 2018/06/06/ PY - 2018/5/8/pubmed PY - 2019/10/1/medline PY - 2018/5/8/entrez KW - lithotripsy KW - nephrolithiasis KW - ureteroscopy SP - 603 EP - 607 JF - Journal of endourology JO - J. Endourol. VL - 32 IS - 7 N2 - INTRODUCTION: Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. METHODS: A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. RESULTS: We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. CONCLUSIONS: Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/29732915/Retrograde_Ureteroscopic_Management_of_Large_Renal_Calculi:_A_Single_Institutional_Experience_and_Concise_Literature_Review_ L2 - https://www.liebertpub.com/doi/full/10.1089/end.2018.0069?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -