The Flexible Ureteroscopy And Holium Laser Lithotripsy For Reanl Calculi

Background Renal calculi as one of the most common diseases in urology, the treatment has been changed greatly in the last 30 years, as the open surgery has almost been replaced by the minimal invasive surgeries. Among them, the flexible ureteroscopy is an important option for the calculi in pelvis and calyxes. For the urologists, it is very important that the enrolled patients, the placement of the scopy, the option of laser and the techniques of the lithotripsy.Objective To investigate the efficacy and safety of the flexible ureteroscopy and Holium laser lithotripsy for reanl calculi. To discuss operative techniques and the factors which effect the lithotripsy.Patients and methods We reviewed all the records of the 53 patients undergoing ureteroscopy and Holium laser lithotripsy for renal calculi from 2009 Jan to 2010 Mar in our hospital retrospectively. All the cases recieved KUB and IVU routinely before the surgeries. Among the cases, there were 11 cases with calculi in renal pelvis,23 cases with calculi located in superior or median calyxes and 19 cases with inferior caliceal calculi.The sizes of calculi are all under 20mm. We inserted the 8.9F Wolf rigid ureteroscopy, by which we observed the ureter and placed a guide wire in it. Then the 14F Cook ureter sheath was inserted to dilate the ureter. The calculi were treated by Olympus URF-P5 flexible ureteroscopy and the Holium laser with the energy set at 0.8-1.2J/8～10Hz. The residual fragments smaller than 3mm were considered to reflect successful lithotripsy. Then the 3F double-J-duct and urethral duct were placed. Intravenous antibiotic prophylaxis were administrated within the first 2 days postoperatively and the urethral catheterization was removed in second or third day after the operation. The double-J-duct was taken out two weeks later. The evaluation of calculi evacuation was performed within one month by KUB or CT scan after operation.Results We succeed in inserting the ureteroscopy in 47 cases (88.7% 47/53). We found the calculi in 43 cases (81.1% 43/53) successfully, among which there were 29 cases of pelvic calculi and superior-median caliceal calculi (85.3% 29/34) and 14 cases of inferior caliceal calculi. The total rate of lithotripsy was 75.5% (40/53). The rate for pelvic calculi and superior, median caliceal calculi was 82.4%(28/34).The rate for inferior calyx was 63.2%(12/19), there was no significance between them (the Fisher's Exact Test, P=0.183). Mean time for the lithotripsy was 48min (32-84min). The total rate of evacuation was 69.8% (37/53),the average time for stonefree was 17±5.3D. The rate for pelvic calculi and superior, median caliceal calculi was 79.4% (27/34). While the rate for inferior calyx was 52.6%(10/19) which was significantly lower (x2=4.148,P=0.042). There were no severe complications in the trial, such as ureteral perforation, avulsion of mucosa and renal failure etc.Conclusion The flexible ureteroscopy and Holium laser lithotripsy show efficacy and safety in the treatment for renal calculi smaller than 20mm.