Objective: The most appropriate treatment of lower caliceal stones, yet remains unclear. Treatment options are SWL, retrograd interna lsurgery(RIRS), percutan nephrolitotomy and rarely open classic surgery. RIRSwere introdu-ced more frequently in recent years becasue of realtive morbidity risk of PNL and low success rate of SWL. We aimed in present study to eva-luatethe success rate of RIRS procedures in pa-tients with an unsuccessfull SWL history.
Material and Methods: 42 patients (12 wo-men and 30 men) enrolled to study which have undergone retrograd internal surgery after un-successfull SWL between 2008 January and 2011 May. Treatment was performed for lower caliceal Stones by using 8 F Storz x2 flexflexible URS. Urography or contrast enhanced compu-ted tomograpy was performed before surgery to evaluate caliceal anatomy and the size of stones. Lithotripsy was performed by a holmium:YAG laser probe with 0,2mm diameter and Stone pi-eces larger than 2mm were remove dup. In app-ropriate cases, lower caliceal stones were captu-red by N-gage basket and moved to renal pel-vis for lithotripsy. Double j or uretherial cathe-ters were placed in urether if necessary. Residu-al Stone pieces were assessed 4 weeks after sur-gery by direct radiogram and ultrasound and or contrast enhanced CT.
Results: Mean diameter of the stones was 12 mm (5-25mm), mean operation time was 75 minutes (50-125 minutes). 7 patients with Sto-nes lower than 1 cm were not set on the Access sheath. 35 patients with stones greater than1 cmwere all at tempted to affihing Access sheath but in 3 patients, Ac-cess sheath could not be pushed forward to proximal urether. Ballo-on dilatation was performed in 8 cases because of uretheral steno-sis. 2 patients with upper uretheral stricture were treated with do-uble j catheter followed by fURS after 4 weeks. There were nonote-able complications in surgery and in follow upperiod. Mean time fort he discharge from hospital was 1,2 days (1-3 days). All patients were examined after 1 months from surgery. İn control examinati-on, direct radiogram, ultrasoundand / or noncontrastenhancet CT was obtained from all patients. Ultrasound revealed residuel sto-nes with a diameter of 3 mm in lower calices in 5 patients (11,6%). These patients were treated with URS while their double j catheter was removed.
Conclusion: Flexible URS and holmium laser lithotripsy is ef-fective in lower calisiel stone patients with unsuccessfull SWL his-tory.
Key Words: SWL, lower caliceal stone, holmium laser, flexible-ureterorenoscopy, retrograde intrarenal surgery.
Abstract
Objective: The most appropriate treatment of lower caliceal stones, yet remains unclear. Treatment options are SWL, retrograd interna lsurgery(RIRS), percutan nephrolitotomy and rarely open classic surgery. RIRSwere introdu-ced more frequently in recent years becasue of realtive morbidity risk of PNL and low success rate of SWL. We aimed in present study to eva-luatethe success rate of RIRS procedures in pa-tients with an unsuccessfull SWL history.
Material and Methods: 42 patients (12 wo-men and 30 men) enrolled to study which have undergone retrograd internal surgery after un-successfull SWL between 2008 January and 2011 May. Treatment was performed for lower caliceal Stones by using 8 F Storz x2 flexflexible URS. Urography or contrast enhanced compu-ted tomograpy was performed before surgery to evaluate caliceal anatomy and the size of stones. Lithotripsy was performed by a holmium:YAG laser probe with 0,2mm diameter and Stone pi-eces larger than 2mm were remove dup. In app-ropriate cases, lower caliceal stones were captu-red by N-gage basket and moved to renal pel-vis for lithotripsy. Double j or uretherial cathe-ters were placed in urether if necessary. Residu-al Stone pieces were assessed 4 weeks after sur-gery by direct radiogram and ultrasound and or contrast enhanced CT.
Results: Mean diameter of the stones was 12 mm (5-25mm), mean operation time was 75 minutes (50-125 minutes). 7 patients with Sto-nes lower than 1 cm were not set on the Access sheath. 35 patients with stones greater than1 cmwere all at tempted to affihing Access sheath but in 3 patients, Ac-cess sheath could not be pushed forward to proximal urether. Ballo-on dilatation was performed in 8 cases because of uretheral steno-sis. 2 patients with upper uretheral stricture were treated with do-uble j catheter followed by fURS after 4 weeks. There were nonote-able complications in surgery and in follow upperiod. Mean time fort he discharge from hospital was 1,2 days (1-3 days). All patients were examined after 1 months from surgery. İn control examinati-on, direct radiogram, ultrasoundand / or noncontrastenhancet CT was obtained from all patients. Ultrasound revealed residuel sto-nes with a diameter of 3 mm in lower calices in 5 patients (11,6%). These patients were treated with URS while their double j catheter was removed.
Conclusion: Flexible URS and holmium laser lithotripsy is ef-fective in lower calisiel stone patients with unsuccessfull SWL his-tory.
Key Words: SWL, lower caliceal stone, holmium laser, flexible-ureterorenoscopy, retrograde intrarenal surgery.