Treatment For Renal Staghorn Calculi Through Flexible Ureteroscopy With Holmium Laser Lithotripsy

Objective:To evaluate the feasibility, efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy in the treatment of renal staghorn calculi.Methods:From June2011to December2012,12patients with renal staghorn calculi were treated by flexible ureteroscopy with holmium laser lithotripsy in our hospital. The diagnosis was confirmed by B-ultrasonography, KUB+IVP, CT and midstream urine culture. Placement of Double-J stent was performed2weeks preoperatively, antibiotic prophylaxis was administrated2-3days preoperatively, surgeries were performed under general anesthesia. The flexible ureteroscope reached renal pelvis through ureterectasia-scabbard or alongside guidewire, calculi were then broken into gravels by200μm or365μm holmium laser fiber set at an energy level of16-20W or by flexible ureter forceps. Double-J stents were removed by cystoscopy3-4weeks after surgery and re-examinations with B-ultrasonography or CT would be performed2weeks later. Operative time, postoperative stay, stone-free rate, stone-detection rate and occurs of complications were assessed.Results:9patients underwent one-stage operation,2patients underwent two-stage operation and1patient underwent three-stage operation. All stones were detected, stone-free rate was83.3%(10/12). Average operation time was69min (43min-98min) and mean postoperative stay was2.3days (2d-4d).2cases underwent ESWL after surgery due to residual stones. No serious complications such as ureteral perforation, massive hemorrhage or severe infection occurred.Conclusion:Flexible ureteroscopy with holmium laser lithotripsy is a feasible, safe and minimally invasive way to treat renal staghorn calculi. It has few complications and provides a new, as well as effective way in the treatment of staghorn renal calculi.