Outcome of Flexible Ureteroscopy and Holmium Laser Lithotripsy in the Management of Renal Stones: A two‑year Retrospective Study

Abstract

Background: Over the decades, the management of renal stones has shifted from the undesirably invasive open nephrolithotomy to the more effective and less invasive approaches with lower morbidity. These less invasive options include extracorporeal shock wave lithotripsy, percutaneous lithotripsy, and flexible ureterorenoscopy (fURS). Aim: This study seeks to evaluate the outcomes of flexible ureterorenoscopy with holmium: yttrium‑aluminum‑garnet (holmium:YAG) laser lithotripsy for the treatment of renal stones <2.0 cm in our patients. Patients and Methods: Records of 23 patients who underwent flexible ureteroscopy and holmium: YAG laser lithotripsy between October 2020 and September 2022 were reviewed retrospectively. The patients who had the flexible ureteroscopy and laser lithotripsy for renal stones <2.0 cm for various indications were the subjects of this study. All patients had computed tomographic urography preoperatively to locate the stone. Stone‑free rate (SFR) was deduced from no stone detected on imaging and resolution of the patient’s preoperative complaints related to the renal stones at follow‑up. Data on patients’ demographics, indication for the surgery, location of the stone, size of the stone, preoperative double J (DJ) placement, postoperative DJ stent placement, intraoperative and postoperative complications, and the SFR were retrieved and subjected to the statistical analysis. Results: A total of 23 patients had fURS and laser lithotripsy during the two‑year study period. All the patients had solitary stone in the renal unit operated. The mean stone size for all the patients was 1.3 cm (range: 0.5–1.9 cm). Fifteen (65.2%) patients had DJ stent preoperatively. Postoperative DJ stent was placed in all our patients. Four (17.4%) patients had Grade 1 ureteric injury while none had high Grades (2, 3, and 4) ureteral injuries. Two (9.5%) patients had intraoperative bleeding, 1 (4.8%) had transient haematuria
postoperatively while 2 (9.5%) patients had urinary tract infection. The SFR was 91.3% in a single surgery. Two patients (8.7%) had residual fragments in the lower calyx. Conclusion: Flexible ureteroscopy and laser holmium lithotripsy give a satisfactory SFR, with few complications. It is a safe and effective treatment modality for the treatment of stones <2.0 cm in the renal pelvicalyceal system.