Flexible Ureteroscopy and Laser Lithotripsy for Multiple Unilateral Intrarenal Stones: Is this a right choice?
Aim : To assess effectiveness of flexible ureteroscopy (fURS) in patients not with simple but with multiple unilateral renal stones.
Materials and Methods: From September 2014 to October 2015, 140 ureteroscopic procedures were performed in our department; 42 patients who had undergone with multiple unilateral retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study.
Patients were considered stone free if no residual stones were seen radiographically after 3 months. We made an analytical study (uni- and multi-variate) to identify predictors of failure of ureteroscopy. The efficiency and the safety of the procedures were analyzed.
Results: A total of 42 patients ( 22men, 20women) with a mean age 42.4 years were included in the present study. The mean Cumulative Stone Diameter size was 26.4mm (range:15- 45mm). All patients were treated during the same operative session. With a mean operative time 129 of minutes. The stone-free rates (SFR) was 64.5%.The univariate analysis showed a statistical correlation between the failure of URS and the following variables: the headquarters of the stones (p =0,01), cumulative stone diameter size (p=0.009) and number of stones (p<0,001). The multivariate logistic regression analysis retained: the cumulative stone diameter size (p = 0.02) as independent predictive factors of failure of URS. Adverse post ureteroscopy effects were frequent (moderate pelvic pain: 100%, hematuria 100 %).Their intensity was always minimal to moderate. Complications were rare 1.9%. It was minor complications in all cases ( mucosal injury : 1 case; cracking meatus: 3 cases ) not requiring a supplementary procedure
Conclusion: For patients with unilateral multiple calculi, flexible ureteroscopy with holmium laser can represent an alternative option to ESWL or PCNL, along with acceptable efficacy and low morbidity. Only further well-designed, prospective, comparative, and possibly randomized studies will give us the answer.