Efficacy and safety of retrograde flexible ureteroscopic lithotripsy with holmium: YAG laser in the treatment of renal stones

Abstract

Objective To evaluate the efficacy and safety of retrograde flexible ureteroscopic lithotripsy (RFUL) with holmium: YAG laser for the treatment of renal stones with a large series. Methods The data of 466 patients who underwent RFUL with holmium: YAG laser for the treatment of kidney stones between January 2013 and December 2013 were collected.The maximum diameter of stone was 23±16 mm.The stone free rate, complications, retreatment rate were evaluated. Results Out of the 466 patients, the mean operative time and postoperative hospital stay were 33.5±18.8 min and 2.3±2.0 d. The stone free rate was 67.6% (315/466) after single procedure, which increased to 69.5% (324/466) via re-treatments after 3 months.The retreatment rate was 4.3% (20/466), with a total of 493 RFUL procedures performed and 1.06 times per patient.There were 67 (14.4%) cases undergoing complications.Five cases had false passage of ureter orifice causing slight ureteral wall injuries. Steinstrasse occurred in 9 cases, ureteral perforation in 3 cases and perirenal hematoma in 1 case.Overall postoperative fever rate was 10.7% (50/466) with urosepsis in 16 cases (3.4%). When the stone size was ≤10, 11-20, 21-30, 31-40, and >40 mm, the stone free rates after a single procedure were 97.0% (65/67), 84.2% (160/190), 63.1% (70/111), 29.2% (14/48), 12.0% (6/50) (P<0.001), and the postoperative fever rates were 1.5% (1/67), 9.5% (18/190), 13.5% (15/111), 14.6% (7/48), 18.0% (9/50), respectively. The postoperative fever rates were 19.3% (27/140) and 7.1% (23/326) (P<0.001) in the patient with positive and negative preoperative urine leukocyte, and 22.0% (22/100) and 7.7% (28/366) (P<0.001) in patients with positive and negative preoperative urine culture. Conclusions RFUL with holmium: YAG laser is a safe and effective treatment for kidney stones. The postoperative fever rate would increase and stone free rate would reduce with the increased stone size. Key words: Flexible ureteroscopy; Lithotripsy, laser; Kidney calculi; Stone free rate; Complications