Treatment for residual stones using flexible ureteroscopy and holmium laser lithotripsy after the management of complex calculi with single-tract percutaneous nephrolithotomy

• Published in: Lasers in medical science Vol. 32; no. 3; pp. 649 - 654
• Main Authors: Chen, L., Sha, M.-L., Li, D., Zhuo, J., Jiang, C.-Y., Zhu, Y.-P., Xia, S.-J., Lu, J., Shao, Y.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.04.2017; Springer Nature B.V
• Subjects: Adult; Calculi; Clinical outcomes; Dentistry; Female; Holmium; Humans; Kidney Calculi - surgery; Kidney stones; Lasers; Lasers, Solid-State - therapeutic use; Lithotripsy; Lithotripsy, Laser - adverse effects; Lithotripsy, Laser - methods; Male; Management; Medical services; Medical treatment; Medicine; Medicine & Public Health; Middle Aged; Nephrostomy, Percutaneous - adverse effects; Optical Devices; Optics; Original Article; Patients; Photonics; Postoperative Complications - etiology; Quantum Optics; Stone; Treatment Outcome; Ureteroscopes; Ureteroscopy - adverse effects; Flexible ureteroscopy and holmium laser lithotripsy; Complex calculi; Single-tract PCNL
• ISSN: 0268-8921; 1435-604X
• DOI: 10.1007/s10103-017-2162-5

This study validated the effectiveness and safety of the treatment for residual stones using flexible ureteroscopy (fURS) and holmium laser (0.6–1.2 J, 20–30 Hz) lithotripsy via a fiber with a 200-μm core diameter and 0.22 numerical aperture (NA) after the management of complex calculi with single-tract percutaneous nephrolithotomy (PCNL). Between January 2014 and June 2016, 27 consecutive patients with complex calculi underwent fURS and holmium laser lithotripsy after a planned single-tract PCNL. Among the 27 patients with complex calculi, 9 had full staghorn calculi, 7 had partial staghorn calculi, and 11 had multiple calculi. After the first single-tract PCNL session, the mean stone size and mean stone surface area were 18.0 ± 10.7 mm and 181.9 ± 172.2 mm 2 , respectively. Treatment for residual stones with fURS and holmium laser lithotripsy was successfully completed and was performed without intraoperative complications. The mean operative time of the fURS procedure was 69.1 ± 23.6 min, and the mean hospital stay was 5.3 ± 2.4 days. The mean decrease in the hemoglobin level was 7.3 ± 6.5 g/l. After the fURS procedure, the overall stone-free rate was 88.9%. The overall postoperative complication rate was 14.8% (Clavien grade I 11.1%; Clavien grade II 3.7%). The current approach tested here combines the advantages of both PCNL and fURS and effectively manages complex calculi with a high stone-free rate (SFR) (88.9%). This approach also reduced the number of treatment sessions, the number of percutaneous access tracts, and the blood loss and potential morbidity associated with multiple tracts.