The accessibility, efficiency, and cost analysis of flexible ureteroscopy with a holmium:YAG laser in treating large-sized renal calculi

Abstract

As the renal stone size increases, the stone clearance rate using extracorporeal shock wave lithotripsy (ESWL) for renal calculi decreases. For stone sizes >2cm in diameter, the stone clearance rate of ESWL is unsatisfactory. Thereafter, percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice because of a better stone-free rate. However, increased complications and a longer convalescence period with PCNL became more important issues in certain cases. Previous literature reviews reported that ureteroscopic lithotripsy (URSL) can be used as adjunct therapy in combination with PCNL. Some authors even reported an excellent stone-free rate with minimal complications by performing URSL for large renal calculi. Because of the availability of technologically advanced ureteroscope and improved ancillary equipment, such as the holmium laser and ureteral access sheath, this procedure has become more feasible and effective for treating renal calculi. In addition to reviewing stone-free and complication rates, the literature was also reviewed for the total number of procedures carried out, and medical expenses were compared although only a few reports are available on this subject. The contemporary literature supports URSL as a safer, more-efficient, and more cost-effective alternative to PCNL in selected patients.