Abstract
We analyzed the results of single-use flexible ureteroscopy (su-fURS) with the holmium laser in treating renal stones associated with ectopic pelvic kidney (EPK). The study retrospectively analyzed data of 11 patients diagnosed with EPK and stone disease who underwent su-fURS between May 2017 and November 2019. The analyzed surgical data included the mean operation time, stone-free and complication rates, as well as hospitalization period. Disposable digital flexible ureteroscopes were exclusively used. The mean age was 55, with a 1.2:1 male to female ratio. The mean stone burden was 30±9 mm (ranging from 17 to 49 mm). The mean calculi digitized surface area (DSA) was 299±56 mm2 (ranging from 170 to 597 mm2). A ureteral access sheath was used in all 11 patients, and holmium laser lithotripsy was performed (dusting mode parameters: low energy – 0.5J, high frequency – 50 Hz, long pulse; pop-corn mode: high energy >1 J, medium frequency– 10–50 Hz, long pulse; fragmenting mode: high energy >1 J, low frequency <10 Hz, short pulse). The average operative time was 78±19 minutes (ranging from 68 to 144 minutes). The stone-free status (residual fragments <3 mm) after one session was 60.1%, 84.1% after the second session, and 94.4% after the third session. The hospitalization period was 29 hours (ranging from 17 to 39 hours). The overall complications rate (according to the Clavien-Dindo system) was 19.7%. Therefore, su-fURS represents an effective therapeutic approach characterized by a remarkably high stone-free rate and few complications in EPK-associated calculi.
Highlights
Minimal invasive surgery technique is continuously developing, establishing new approaches for different pathologies and completing the idea of personalized treatment with significant benefits
Since flexible ureteroscopes already demonstrated their superiority compared to percutaneous nephrolithotomy (PCNL), Shock wave lithotripsy (SWL) or laparoscopy even when accessing an abnormal urinary tract, this study aims to evaluate the advantages expressed in the safety and efficacy of single-use devices in challenging situations such as an ectopic pelvic kidney
The imagistic evaluation consisted of computed tomography (CT) scans (Figures 1 and 2) or intravenous pyelography (IVP); these tests were performed before the intervention, and several details such as stone size, location, hydronephrosis, or laterality were recorded
Summary
Minimal invasive surgery technique is continuously developing, establishing new approaches for different pathologies and completing the idea of personalized treatment with significant benefits. Nephrolithiasis is one of the most frequent diseases in a urology department, and several methods are nowadays available for sustaining rapid results with minimal risks for the diagnosed patients. An ectopic pelvic kidney is an anomalous condition that originates from embryological development [1]. Reported incidence for this variety of pathology was estimated to be 1 to 220–3000 cases [2]. Renal drainage can be severely affected, and as a direct consequence, urolithiasis increases the risk of further complications [3, 4]
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