1531 IMPACT OF RENAL ANATOMY ON FLEXIBLE URETERORENOSCOPY FOR LOWER POLE STONES

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131531 IMPACT OF RENAL ANATOMY ON FLEXIBLE URETERORENOSCOPY FOR LOWER POLE STONES Jan Jessen, Patrick Honeck, Thomas Knoll, and Gunnar Wendt-Nordahl Jan JessenJan Jessen Sindelfingen, Germany More articles by this author , Patrick HoneckPatrick Honeck Sindelfingen, Germany More articles by this author , Thomas KnollThomas Knoll Sindelfingen, Germany More articles by this author , and Gunnar Wendt-NordahlGunnar Wendt-Nordahl Sindelfingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3021AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of renal anatomy on the success rate of flexible ureterorenoscopy (URS) for treatment of lower pole stones is less clear than it is on shock wave lithotripsy. Aim of our study was to analyze the influence of the collecting system's configuration on the success rate of URS for lower pole stones using modern endoscopes. METHODS We evaluated 111 consecutive patients from our prospectively kept database who were treated with flexible URS for lower pole stones. Analyzed parameters included stone size, infundibular length (IL) and width (IW), infundibular-pelvic angle (IPA), stone free rate (SFR) and surgery time (OR-Time). Modern flexible endoscopes (Flex X2, Karl Storz, Germany) and holmium laser lithotripsy (Auriga XL, Starmedtec, Germany) were used. Univariate and multifactorial statistical analysis using logistic and linear regression was performed. RESULTS 98 (88.3%) of the 111 patients treated with flexible URS for a lower pole stone were stone free after a single procedure, whereas 13 patients (11.7%) required a second intervention. The results of the two groups are displayed in the Table. Multifactorial analysis revealed a significant influence of stone size and IL on the overall stone free rate (p<0.01), whereas IW had no influence. A steep infundibular-pelvic angle was also associated with a reduced stone free rate, however, this was on the edge of statistical significance. Stone size was the only significant influence factor for OR-time (p<0.001) both in univariate and multifactorial analysis. CONCLUSIONS Our study suggests a negative impact of a high infundibular length on the success rate of flexible URS for treatment of lower pole stones, whereas a narrow infundibulum seems to have no negative effect. A steep infundibular-pelvic angle was also associated with a reduced stone free rate, however statistical significance was just not reached. Stone Free Not Stone Free p-value Age 50.37 ± 16.3 yrs 52.77 ± 14.23 yrs 0.4 Stone Size 6.73 ± 2.98 mm 10.31 ± 6.84 mm 0.009 Infundibular-pelvic angle (IPA) 47.3 ±17.53° 34.55 ± 26.58° 0.085 Infundibular width (IW) 6.02 ± 2.45 mm 6.22 ± 3.38 mm 0.71 Infundibular length (IL) 22.54 ± 6.02 mm 28.25 ± 5.8 mm 0.002 OR-Time 65.49 ± 32.81 min 111.54 ± 54.73 min 0.0009 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e627 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jan Jessen Sindelfingen, Germany More articles by this author Patrick Honeck Sindelfingen, Germany More articles by this author Thomas Knoll Sindelfingen, Germany More articles by this author Gunnar Wendt-Nordahl Sindelfingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...