Flexible Ureterscopy For The Treatment Of Residual Stones After PCNL

OBJECTIVE:To evaluate the clinical value of flexible ureterscopy for the treatment of residual stones after percutaneous nephrolithotomy(PCNL).METHODS:52 cases who underwent PCNL with resident stones in the First Affiliated Hospital of Guangxi Medical University from December 2014 to October 2016 were included in our study,They were treated subsequently using the technique of flexible ureterscopy(retrograde intrarenal surgery,RIRS,or anterograde flexible ureterscopy,AFU,through the percutaneous access tracts)to manage the resident stones.Of them,37 were male and 15 were female,aged from 23-59 Y,with an average of 45±6.4 Y.The post PCNL times were0-61 d.All the cases had the double J stent placement.The access tracts for renal drainage of 10 cases were still at place.Among the 52 cases,48 cases(92.3%)were performed one access tract in PCNL,while only 4 cases(7.7%)were performed more than two access tracts.The resident stones in most of the cases were two or more stones,distributed in 1-7 calices.Single stone was0.8-2.4 cm in diameter respectively.For the radiolucent stones,the diameter of stone is bigger than 0.5 cm.The clinic data were recorded,including theoperating time,the postoperative stay,the fever and urosepsis rates,the transfusion rate,second RIRS procedure rate,the clearance rate.RESULTS:47 cases(90.4%)were treated by RIRS,with 100% successive placement of the shelf.5 cases(9.6%)were treated by AFU through the percutaneous tracts,while 2 cases failed and were successively underwent RIRS subsequently.The average time of flexible ureterscopy were 20-90min(average42±17 min).Among those who underwent RIRS,5 cases(10.2%)received two RIRS procedures,while 44 cases(89.8%)received only one RIRS procedures.There were still residual stones in 4 cases after the treatment.For the complication,only two cases had the fever after the flexible ureterscopy.None of the patient who had the renal drainage had the fever.No transfusion case.The post operation stay were1.3±0.3d.After 1-6 M of the follow up,84.8% of the cases had the clearance rate.CONCLUSIONS:It is safe and effective to treat the residual stones after PCNL by flexible ureterscopy.