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67th Annual Meeting Abstracts
Ureteroscopic Management of Large Intrarenal Calculi - A Comparison of Techniques
Nicholas T Leone1, Scott G Hubosky1, *Albert J Mariani2, Demetrius H Bagley1
1Thomas Jefferson University Hospital, Philadelphia, PA;2Kaiser Hospital, Honolulu, HI
Introduction: Retrograde intracorporeal lithotripsy represents a viable alternative to percutaneous nephrostolithotomy for the treatment of large intrarenal calculi. We compare the outcomes of differing ureteroscopic techniques, including holmium laser and electrohydraulic lithotripsy, in the setting of intrarenal calculi >2cm.
Materials & Methods: A total of 79 consecutive patients underwent urerteroscopic lithotripsy of intrarenal calculi >2cm by one of three at surgeons at two separate institutions. Demographic data, intraoperative techniques, success rates and complications were compared. Successful clearance of stones was defined as an absence of residual fragments measuring larger than 2mm on post-operative imaging or last ureteroscopy.
Results: Mean stone size for all patients was 29.6mm. Mean operative time was 111.1 minutes. Successful stone clearance was achieved in 76 patients (96.2%), and required an average of 1.4 ureteroscopic lithotripsy treatment episodes per patient. Primary electrohydraulic lithotripsy resulted in shorter operative times (p=0.0000) and required fewer treatment episodes (p=0.0024) compared to primary laser lithotripsy. The final success rate was similar for each group (p=0.332). There was no difference in the number of unplanned ancillary procedures performed for post-operative complications (p=0.4103).
Conclusions: Retrograde ureteroscopic lithotripsy offers excellent success and retreatment rates for the treatment of large intrarenal calculi >2cm, similar to gold-standard percutaneous nephrostolithotomy. Significantly shorter operative times and higher initial success rates were obtained when electrohyrdaulic lithotripsy was the primary treatment modality, but overall success was not significantly different when compared to holmium laser lithotripsy. Complimentary use of both techniques can help to achieve optimal results.
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