Flexible Ureteroscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones

Background: External shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) have been the standard of care for the treatment of intrarenal calculi. Objective: We sought to determine the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of multiple intrarenal calculi and further stratify the efficacy by stone burden less than and greater than 20 mm. Design, setting, and participants: Patients with multiple unilateral renal calculi treated between 2000 and 2006 at a single tertiary academic center were retrospectively evaluated. Intervention: All patients underwent retrograde flexible ureteroscopy and holmium laser lithotripsy. Measurements: Stone-free status was determined by ureteroscopy 15 d after the last procedure and was defined as the absence of stones in the kidney or residual fragments <1 mm. A renal ultrasound was performed 30 d after the last treatment to confirm the absence of stones and hydronephrosis. Results and Limitations: Fifty-one patients were identified for a total of 161 intrarenal calculi with a mean stone size per patient of 6.6 +/- 3 mm (range: 215). The mean number of stones per patient was 3.1 +/- 1 (range: 2-6). The mean number of primary procedures was 1.4 +/- 0.6 (range: 1-3). The overall stone-free rates after one and two procedures were 64.7% and 92.2%, respectively. The stone-free rates for patients with a stone burden greater than and less than 20 mm were 85.1% and 100%, respectively. The overall complication rate was 13.6%; 97.6% of cases were performed as outpatient procedures. There are some limitations to this study, however: This is a retrospective review from a single institution, and our results are based on a relatively small sample size. Conclusions: For select patients with multiple intrarenal calculi, flexible ureteroscopy with holmium laser lithotripsy may represent an alternative therapy to ESWL or PNL, with acceptable efficacy and low morbidity. Published by Elsevier B.V. on behalf of European Association of Urology.