Preliminary Study Of Flexible Ureteroscopy Combined With Holmium Laser Lithotripsy For Complicated Renal Calculi

Objective:To evaluate the efficacy and safety of flexible ureteroscopecombined with holmium laser lithotripsy for treatment of complicatedrenal calculi.Methods:From June2014to March2015, a total of28patients withcomplicated renal calculi received flexible ureteroscopy and holmiumlaser lithotripsy in First Hospital of Jilin University. Among the cases,15cases were incomplete staghorn stones;4cases were postoperativeresidual stones after percutaneous nephroscope lithotomy;1case was liein the lower part of a repeated renal;3cases had narrow ureter;3patientsowned isolated kidney on the function;2cases were overly obese patients.The calculi were located at the upper calyx in1patient(with the longestdiameter of1.6cm), at the middle calyx in3(ranged from1.0-1.6cm inthe longest diameter), at the lower calyx in5(ranged from1.0-1.7cm),atthe renal pelvis in3(ranged from1.1-1.3cm),at the renal pelvis andmiddle calyx in12(ranged from1.5-2.3cm),at the renal pelvis and lowercalyx in3(ranged from2.0-2.1cm). Evaluate preoperative parameters,operation time, stone clearance rate, postoperative hospitalization days, and days of indwelling catheter and complications, and so on.Results:All stones were successfully detected.85.7%(24/28)of patients werestone free, overall.50%（4/8）of patients with the calculi located at lowercalyx were stone free. The others were all stone free. The averageduration of operation was89.4±29.0min(ranged from45-141min). Timeof indwelling catheter were1-3days（mean time82±0.77days）.Thepatients were discharged from hospital in2-4days(mean time2.71±0.76days) after operation. There were11minor complications,including2cases of fever and2cases of pain and7case of gross hematuria. Nosevere complications were identified.Conclusion:Flexible ureteroscopy combined with holmium laser lithotripsy is aneffective and safe choice for complicated renal calculi because of higherstone-free rate and fewer complications, but the efficacy on the treatmentof the calculi located at the lower calyx is not as good as the othercalyxes.