Skip to main content
SpringerLink
Log in

Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm

  • Original Paper
  • Published:
Urological Research Aims and scope Submit manuscript

Abstract

The objectives of this study are to assess the efficacy and safety of retrograde ureteroscopic holmium laser lithotripsy for intrarenal calculi greater than 2 cm in diameter. A total of 24 patients with a stone burden >2 cm were treated with retrograde ureteroscopic laser lithotripsy. Primary study endpoints were number of treatments until the patient was stone free and perioperative complications with a follow-up of at least 3 months after intervention. In 24 patients (11 women and 13 men, 20–78 years of age), a total of 40 intrarenal calculi were treated with retrograde endoscopic procedures. At the time of the initial procedure, calculi had an average total linear diameter of 29.75 ± 1.57 mm and an average stone volume of 739.52 ± 82.12 mm3. The mean number of procedures per patient was 1.7 ± 0.8 (range 1–3 procedures). The overall stone-free rate was 92%. After 1, 2 and 3 procedures 54, 79 and 92% of patients were stone free, respectively. There were no major complications. Minor postoperative complications included pyelonephritis in three cases (7.5%), of whom all responded immediately to parenteral antibiotics. In one patient the development of steinstrasse in the distal ureter required ureteroscopic fragment disruption and basketing. Ureteroscopy with holmium laser lithotripsy represents an efficient treatment option and allows the treatment of large intrarenal calculi of all compositions and throughout the whole collecting system even for patients with a stone burden of more than 2 cm size.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Albala DM, Assimos DG, Clayman RV et al (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis—initial results. J Urol 166:2072–2080

    Article  CAS  PubMed  Google Scholar 

  2. Desai M, Jain P, Ganpule A, et al (2009) Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi. BJU Int

  3. Preminger GM, Assimos DG, Lingeman JE et al (2005) Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173:1991–2000

    Article  PubMed  Google Scholar 

  4. Shah H, Khandkar A, Sodha H et al (2009) Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int 104:840–846

    Article  PubMed  Google Scholar 

  5. Soucy F, Ko R, Duvdevani M, et al (2009) Percutaneous nephrolithotomy for staghorn calculi: a single center’s experience over 15 years. J Endourol

  6. Hafron J, Fogarty JD, Boczko J, Hoenig DM (2005) Combined ureterorenoscopy and shockwave lithotripsy for large renal stone burden: an alternative to percutaneous nephrolithotomy? J Endourol 19:464–468

    Article  PubMed  Google Scholar 

  7. Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51:899–906 discussion 06

    Article  PubMed  Google Scholar 

  8. Ricchiuti DJ, Smaldone MC, Jacobs BL et al (2007) Staged retrograde endoscopic lithotripsy as alternative to PCNL in select patients with large renal calculi. J Endourol 21:1421–1424

    Article  PubMed  Google Scholar 

  9. Grasso M, Conlin M, Bagley D (1998) Retrograde ureteropyeloscopic treatment of 2 cm or greater upper urinary tract and minor staghorn calculi. J Urol 160:346–351

    Article  CAS  PubMed  Google Scholar 

  10. Busby JE, Low RK (2004) Ureteroscopic treatment of renal calculi. Urol Clin North Am 31:89–98

    Article  PubMed  Google Scholar 

  11. Grasso M, Ficazzola M (1999) Retrograde ureteropyeloscopy for lower pole caliceal calculi. J Urol 162:1904–1908

    Article  CAS  PubMed  Google Scholar 

  12. Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG (2008) Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater—is this the new frontier? J Urol 179:981–984

    Article  PubMed  Google Scholar 

  13. El-Anany FG, Hammouda HM, Maghraby HA, Elakkad MA (2001) Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi. BJU Int 88:850–853

    Article  CAS  PubMed  Google Scholar 

  14. Mariani AJ (2007) Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 177:168–173, discussion 73

    Article  PubMed  Google Scholar 

  15. Johnson GB, Portela D, Grasso M (2006) Advanced ureteroscopy: wireless and sheathless. J Endourol 20:552–555

    Article  PubMed  Google Scholar 

  16. Vassar GJ, Chan KF, Teichman JM et al (1999) Holmium: YAG lithotripsy: photothermal mechanism. J Endourol 13:181–190

    Article  CAS  PubMed  Google Scholar 

  17. Teichman JM, Vassar GJ, Bishoff JT, Bellman GC (1998) Holmium:YAG lithotripsy yields smaller fragments than lithoclast, pulsed dye laser or electrohydraulic lithotripsy. J Urol 159:17–23

    Article  CAS  PubMed  Google Scholar 

  18. Schuster TG, Hollenbeck BK, Faerber GJ, Wolf JS Jr (2002) Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ and after displacement. J Urol 168:43–45

    Article  PubMed  Google Scholar 

  19. Kim SC, Kuo RL, Lingeman JE (2003) Percutaneous nephrolithotomy: an update. Curr Opin Urol 13:235–241

    Article  PubMed  Google Scholar 

  20. Segura JW, Patterson DE, LeRoy AJ et al (1985) Percutaneous removal of kidney stones: review of 1,000 cases. J Urol 134:1077–1081

    CAS  PubMed  Google Scholar 

  21. Stoller ML, Wolf JS Jr, St Lezin MA (1994) Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 152:1977–1981

    CAS  PubMed  Google Scholar 

  22. Lang EK (1987) Percutaneous nephrostolithotomy and lithotripsy: a multi-institutional survey of complications. Radiology 162:25–30

    CAS  PubMed  Google Scholar 

  23. Clayman RV, Surya V, Hunter D et al (1984) Renal vascular complications associated with the percutaneous removal of renal calculi. J Urol 132:228–230

    CAS  PubMed  Google Scholar 

  24. Miller NL, Lingeman JE (2007) Management of kidney stones. BMJ 334:468–472

    Article  PubMed  Google Scholar 

  25. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW (1997) Ureteroscopy: current practice and long-term complications. J Urol 157:28–32

    Article  CAS  PubMed  Google Scholar 

  26. Hyams ES, Shah O (2009) Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol 182:1012–1017

    Article  PubMed  Google Scholar 

  27. Tan YH, Wong M (2005) How significant are clinically insignificant residual fragments following lithotripsy? Curr Opin Urol 15:127–131

    Article  PubMed  Google Scholar 

  28. Streem SB, Yost A, Mascha E (1996) Clinical implications of clinically insignificant store fragments after extracorporeal shock wave lithotripsy. J Urol 155:1186–1190

    Article  CAS  PubMed  Google Scholar 

  29. Raman JD, Bagrodia A, Gupta A et al (2009) Natural history of residual fragments following percutaneous nephrostolithotomy. J Urol 181:1163–1168

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany

    M. J. Bader, C. Gratzke, S. Walther, P. Weidlich, M. Staehler, M. Seitz, O. Reich, C. G. Stief & B. Schlenker

  2. Laser Research Laboratory/LIFE Center, Ludwig-Maximilians-University Munich, Munich, Germany

    M. J. Bader & R. Sroka

Authors
  1. M. J. Bader
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Gratzke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Walther
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Weidlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Staehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Seitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Sroka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. O. Reich
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. G. Stief
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B. Schlenker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. J. Bader.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bader, M.J., Gratzke, C., Walther, S. et al. Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm. Urol Res 38, 397–402 (2010). https://doi.org/10.1007/s00240-010-0258-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-010-0258-5

Keywords

Search

Navigation