1899 LONG-TERM RETREATMENT AFTER URETEROSCOPIC LASER LITHOTRIPSY DEPENDS ON EFFECTIVENESS OF INITIAL FRAGMENT CLEARANCE

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101899 LONG-TERM RETREATMENT AFTER URETEROSCOPIC LASER LITHOTRIPSY DEPENDS ON EFFECTIVENESS OF INITIAL FRAGMENT CLEARANCE Penny Tatman, Andrew Heinisch, Mark Laliberte, Caroline Dietz-Carlson, and Andrew Portis Penny TatmanPenny Tatman More articles by this author , Andrew HeinischAndrew Heinisch More articles by this author , Mark LaliberteMark Laliberte More articles by this author , Caroline Dietz-CarlsonCaroline Dietz-Carlson More articles by this author , and Andrew PortisAndrew Portis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1853AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroscopic laser lithotripsy (URS) is an effective method for clearing moderate volume stone burden. In long-term follow-up, we examine retreatment rates and explore prognostic factors. METHODS All patients treated by flexible URS with laser lithotripsy for upper tract calculi by a single surgeon with a standardized technique attempting complete fragment clearance between 04/2003 and 05/2005 were identified. Combining chart review and computer record review, details of procedures and outcomes were collected. RESULTS A total of 239 renal units in 227 subjects were evaluated. Multiple calculi were treated in 43% of renal units. Excluding renal units with nephrocalcinosis, the average number of stones was 1.7±1.2. Stones were located in the proximal ureter (42%), lower pole (38%), and renal non-lower pole (54%). Predominant stone composition was calcium oxalate (68%), calcium phosphate (21%), uric acid (9%), or cystine (1%). Computed tomography (CT) was performed approximately 1 month after surgery in 181 (76%) renal units and categorized as stone free (49%), <2mm (22%), 2-4mm (19%), >4mm (10%). Mean follow-up was 3.8±1.3 years. Future ipsilateral procedures were performed in 28 (12%) patients at an average of 1.2±1.2 years. Retreatment was greater in renal units with multiple calculi (17% vs 7%, p=0.02) and nephrocalcinosis (25% vs 10%, p=0.02). There was no difference in retreatment by stone volume, location or composition. Cumulative retreatment rate (CRR) at 5 years was associated with size of residual fragments with stone free (5.7%), <2mm (5.3%), 2-4mm (20.5%), and >4mm (44.4%) (p<0.001, figure 1). Cox regression demonstrated that patients with > 2mm residual fragments were 4.6 times more likely to be retreated than stone-free patients after adjustment for stone number and nephrocalcinosis. There was no increased risk of retreatment for patients with ≤2mm residual fragments compared to stone-free. After adjustment for residual fragments, neither multiple stones nor nephrocalcinosis increased risk of retreatment. CONCLUSIONS Patients with residual fragments < 2mm on postoperative CT following URS can expect long-term freedom from retreatment. Residual fragments > 2mm were associated with higher retreatment rates. St. Paul, MN© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e738 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Penny Tatman More articles by this author Andrew Heinisch More articles by this author Mark Laliberte More articles by this author Caroline Dietz-Carlson More articles by this author Andrew Portis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...