Ureteroscopy and Holmium: YAG Laser Lithotripsy as Emergency Treatment for Acute Renal Failure Caused by Impacted Ureteral Calculi

Abstract

To present our clinical outcomes in managing acute renal failure caused by impacted ureteral calculi with ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy as emergency treatment. A series of 27 patients with acute postrenal failure were treated from November 2002 to December 2005. Impacted calculi were located in bilateral ureters in 22 patients and unilateral ureters in 5 patients with a solitary or single functioning kidney. Acute renal failure was demonstrated with oliguria or anuria and a significant increase in serum creatinine and blood urea nitrogen. Patients were treated emergently with ureteroscopy and holmium:yttrium-aluminum-garnet laser lithotripsy in the hospital within 24 hours. Ureteral stenting was performed in all cases. Postoperative renal function, electrolytes, and urine volume were monitored daily for 7 days. Radiography and/or ultrasonography were performed at a follow-up visit in 4 weeks. Ureteroscopy and laser lithotripsy were successfully performed in all patients. The mean operative time was 29.2 minutes (range 15-60). The successful fragmentation rate in the ureteroscopic procedure was 93.9% (46 of 49), and the overall stone-free rate was 88.9% (24 of 27). Shock wave lithotripsy was used in 3 patients after recovery of renal function. Of the 27 patients, 26 (96.3%) returned to normal renal function within 7 days. One patient (3.7%) had significant improvement of renal function, but it had not returned to normal at 12 weeks of follow-up. No intraoperative complications or postoperative ureteral stricture occurred. Emergency ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy can be safely and successfully performed by skilled endourologists for acute renal failure caused by impacted ureteral calculi.