Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm

The effect of hydronephrosis grade on stone-free rate in retrograde intrarenal stone surgery with flexible ureterorenoscopy

OBJECTIVE

Hydronephrosis, which may be caused by kidney stones in the collecting system, may induce permanent flank pain and damage to kidney function. In this study, we aimed to examine whether the presence of hydronephrosis in the patient has an effect on the stone-free rates in flexible ureterorenoscopy (FURS) applications.

METHOD

The study was carried out retrospectively with 164 patients. Stone size was calculated as volume in computed tomography. Preoperative patient demographic data, radiographic stone characteristics, operational findings, complication status and postoperative 1st month results were recorded.

RESULT

The mean stone-free rate was found to be 61.5%. It was determined that age, gender, side, number, size and the Hounsfield Unit of the stone, the presence of preoperative extracorporeal shock wave lithotripsy (ESWL) history and the presence of hydronephrosis and its degree did not affect the stone-free rate. However, it was concluded that preoperative percutaneous nephrolithotomy (PNL) application and prolonged operation time were found to affect statistically significant stone-free rate. In addition, '2' was found to be the cut-off value for hydronephrosis in the receiver operating characteristic analysis.

CONCLUSION

The presence of preoperative hydronephrosis does not decrease the success of FURS. However, it can be expected that the success of FURS will decrease as grade 2 or more severe grade of hydronephrosis. Therefore, we think that other treatment modalities such as ESWL and PNL should be prioritized in patients with grade 2 and more severe grade of hydronephrosis.

Is semirigid ureteroscopy sufficient in the treatment of proximal ureteral stones? When is combined therapy with flexible ureteroscopy needed?

The goals of this study were to examine cases of proximal ureteral stones in which semirigid or flexible ureteroscopes alone were insufficient for endoscopic treatment, requiring the combination of both. A total of 137 patients were retrospectively evaluated. Holmium laser was used as the energy source for stone fragmentation. Each operation was begun with a 6/7.5 Fr semirigid ureteroscope (URS), and continued with a 7.5 Fr flexible URS in those procedures that failed to reach the stone or push-up. Double J stents were inserted into those patients in whom the flexible URS failed. Shock wave lithotripsy (SWL) or a repeat ureteroscopy (after 2-4 weeks) was planned in those patients who were considered to be treated unsuccessfully. The demographic features of the patients, stone sizes, treatment outcomes, need for additional treatment, complications, and the results of the postoperative 1-month early follow-up were evaluated. The mean age of the patients (77 males and 60 females) was 38 ± 6.7 years old, the mean stone size was 12.3 ± 3.7 mm, and the number of patients with persistent hydronephrosis was 86 (62.8 %). A stone-free diagnosis was achieved in a total of 124 patients (90.5 %), using a semirigid URS in 80 patients and a flexible URS in 44 patients. Treatment using a flexible URS was administered in 38 patients (27.7 %) due to push-up, and in 6 patients (4.3 %) because of the failure to advance the semirigid URS into the ureter. The treatment failed in 13 patients (9.4 %) despite the use of both methods. Treatment using low-caliber semirigid ureteroscopy and a holmium laser is possible, regardless of the stone size, in female patients without hydronephrosis. However, the need for combined treatment with flexible ureteroscopy is increased in male patients with hydronephrosis.