Comparison Of The Efficacy Of Flexible Ureteroscope Combined With Holmium Laser Lithotripsy For Single And Multiple Renal Calculi Size Below 20mm

OBJECTIVE:In this paper,the ureteroscopy combined with holmium laser lithotripsy was used to treat the clinical cases of single and multiple renal calculi with stones less than 20mm,and the applicability of ureteroscopy combined with holmium laser lithotripsy in the treatment of multiple renal calculi was discussed.METHODS:The clinical data of 110 patients with calculi less than 20mm were treated with ureteroscopy and holmium laser lithotripsy from December 2014 to November 2014.All cases were greater than or equal to 18 years old and without abnormal renal anatomy.All cases were divided into two groups,One group of 55 cases with single kidney stones and the other group of 55 cases with multiple kidney stones.There were no significant differences between age,gender and calculi load.The group of 55 cases with multiple kidney stones were divided into two sub groups,one subgroup with lower calyceal calculi and one subgroup with lower calyceal,in order to assess the efficacy of treatment with flexible ureteroscope in the subgroup with lower calyceal calculi specially.RESULTS:There were no significant differences in the type of surgical equipment between the two groups,although the average operative time was longer in the multiple stones group,but there was no statistically significant difference(P = 0.407).The average time of hospital stay was 3.6 ± 0.4 days in the single kidney stones group and 4.1 ± 0.5 days in the multiple kidney stones respectively.The number of cases with complications in the multiple stones group was slightly higher,but there was no statistically significant difference compared with the single stone group.Severe postoperation pain was the most common adverse event.The frequencies in the single renal stone group and multiple stones group were 7(12.7%)and 8(14.5%)respectively.Postoperative need of adjust the use of antibiotics in patients with fever in the single group only occurred in 1 case,and there are 4 cases in the multiple stones group.Postoperative severe gross hematuria in the two groups were 2 and 3 cases respectively,all patients were not receiving blood transfusion.After one time ureteral soft lithotripsy,the removal rate of stones was significantly different between the two groups,96.4%and 83.6%(P =0.026).In the multiple stones group,1 patient received secondary time ureteral soft lithotripsy and obtained complete fruiting.The follow-up data at 3 months after operation showed that the total stone clearance rates were 98.2%and 85.5%(P = 0.037)respectively.CONCLUSION:For multiple renal calculi,flexible ureteroscope combined with holmium laser lithotripsy still has a good rate of fruiting and a lower incidence of complications,but this conclusion also requires prospective randomized clinical trials to further confirm.