Combined laparoendoscopic single-site ureterolithotomy and flexible cystoscopy in the treatment of concurrent large upper ureteral and renal stones

Abstract

Objective: The aim of this study was to present the authors’ experience with technical recommendations for the treatment of concurrent large upper ureteral and renal stones.Methods: Between September 2014 and March 2016, laparoendoscopic single-site surgery (LESS) ureterolithotomy with renal stone extraction or holmium laser lithotripsy under flexible cystoscopy was performed on 15 patients who had concurrent upper ureteral and renal stones. The ureteral stone was treated with LESS ureterolithotomy. After the ureteral stone had been removed, a flexible cystoscope was inserted through one of the laparoscopic ports into the renal pelvis and collecting systems. Renal stones were extracted with a stone basket or broken by a holmium laser and then removed. The perioperative and postoperative data were collected and analyzed retrospectively. Patients were followed up postoperatively for evidence of long-term side-effects.Results: Nine patients underwent LESS ureterolithotomy and flexible cystoscope-assisted renal stone extraction. Six patients underwent concomitant holmium laser lithotripsy because of larger renal stones. All procedures were completed successfully. The ureteral stones were 15–23 mm in diameter and the renal stones were 4–20 mm in diameter. The mean surgery time was 156 min. Estimated blood loss was 70 ml. Complete stone clearance was confirmed by postoperative imaging in all patients. The median length of hospital stay after surgery was 9.1 days. No intraoperative or postoperative complications occurred during a mean follow-up of 10.2 months.Conclusions: LESS ureterolithotomy with renal stone extraction or holmium laser lithotripsy under flexible cystoscopy can be considered an effective treatment for patients with concurrent large ureteral and renal stones.