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Alternative Management Of Complex Renal Stones
Millie Pevzner1, Jeffrey C Yeamans1, Christian DeBeck2, John J Pahira1
1Georgetown University Hospital, Washington, DC;2Washington Hospital Center, Washington, DC
Introduction: The urologist often faces difficult management decisions when treating large renal calculi, particularly in patients with significant comorbidities. While percutaneous nephrolithotomy is considered the gold standard for significant stone burden, in many patients this may be suboptimal. We reviewed our experience with ureterorenoscopy and Holmium laser lithotripsy (UL) for the primary management of large and complex intrarenal calculi.
Materials and Methods: 43 patients with large (2cm or greater) renal or staghorn calculi were treated with primary UL between May 1999 and December 2005. Seven patients were morbidly obese, three had solitary kidneys, 2 had horseshoe kidneys, three had Hepatitis C Virus, and three were self-pay and refused hospital admission. We calculated the total amount of stone burden and location, composition of calculi, number of procedures necessary, and operative time.
Results: In 41/43 patients (95%), complete ureterorenoscopic fragmentation of the stone burden was accomplished. The mean number of procedures necessary to clear all stone was 2.2 (range 1-7). The mean stone size was 4.18cm (range 2-8cm). The mean operative time was 108.9 minutes per procedure (range 52-270 minutes). Two patients were treatment failures, i.e. required further intervention following ureteroscopy. In each case, a single ESWL cleared the remaining stone burden. No patient required subsequent PCNL and there were no major complications.
Conclusions: This series demonstrates the safety and efficacy of ureterorenoscopy and Holmium laser lithotripsy as primary treatment for large, complex kidney stones. It is an attractive alternative to PCNL, particularly in those with comorbid conditions.
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