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Flexible ureteroscopy for large renal stones: Are we pushing the limits: A multi-center retrospective analysis

Article

Last updated: 21 Dec 2024

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Abstract

Background: Managing large renal stones presents challenges. While percutaneous nephrolithotripsy (PCNL) is the gold
standard, flexible ureteroscopy (f-URS) with laser technology has emerged as a minimally invasive alternative.
Objective: To evaluate the outcomes of f-URS for renal stones larger than 20 mm in three centers and identify factors
that influence stone-free rates (SFR).
Patients and Methods: A retrospective analysis of 423 patients who underwent f-URS with holmium laser lithotripsy
for renal stones greater than or equal to 20 mm between January 2021 and October 2023 was conducted. Data from
three centers in UAE, Canada, and Egypt were analyzed. Stone size, site, density, preoperative stenting, operative time,
postoperative complications, and SFR at 30 days were assessed. Univariate and multivariate analyses were performed to
identify factors influencing SFR.
Results: A total of 103 patients met the inclusion criteria. The median stone size was 25 mm. Preoperative stents were
inserted in around half of the cohort. Disposable f-URS and ureteral access sheath were used in the majority of patients.
Median operative time was 94 min. Postoperative complications occurred in 21%. Significant residual fragments were
assessed 30 days postoperatively, around 50% of the study cohort required auxiliary procedures. Univariate analysis
revealed no significant associations between SFR and stone size, location, number, density, or preoperative stenting.
Conclusion: In this multi-center study, f-URS with holmium laser lithotripsy could not achieve decent early stone-free
rates for large renal stones, further research is needed to optimize treatment strategies for large renal stones.

DOI

10.21608/EJSUR.2024.357136

Keywords

Flexible Ureteroscopy, Laser, renal, stones

Authors

First Name

Hani

Last Name

Nour

MiddleName

-

Affiliation

Department of Urology, Theodor Bilharz Research Institute, Giza

Email

-

City

-

Orcid

-

First Name

Hazem

Last Name

Elmansy

MiddleName

-

Affiliation

Thundar Bay Regional Health Science Center, Northern Ontario School of Medicine, Ontario, Canada

Email

-

City

-

Orcid

-

First Name

Ayman

Last Name

Ali

MiddleName

-

Affiliation

Department of Urology, Theodor Bilharz Research Institute, Giza

Email

-

City

-

Orcid

-

First Name

Younis

Last Name

Alshamsi

MiddleName

-

Affiliation

AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Email

-

City

-

Orcid

-

First Name

Amr

Last Name

Hodhod

MiddleName

-

Affiliation

Thundar Bay Regional Health Science Center, Northern Ontario School of Medicine, Ontario, Canada

Email

-

City

-

Orcid

-

First Name

Afaf

Last Name

Mogharbel

MiddleName

-

Affiliation

AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Email

-

City

-

Orcid

-

First Name

Amin

Last Name

Fraij

MiddleName

-

Affiliation

AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Email

-

City

-

Orcid

-

First Name

Mohamed

Last Name

Gadelmoula

MiddleName

-

Affiliation

AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Email

-

City

-

Orcid

-

First Name

Ahlam

Last Name

Busaber

MiddleName

-

Affiliation

AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Email

-

City

-

Orcid

-

First Name

Ahmad

Last Name

Ismaila

MiddleName

-

Affiliation

Department of Urology, Theodor Bilharz Research Institute, Giza

Email

-

City

-

Orcid

-

Volume

43

Article Issue

3

Related Issue

48897

Issue Date

2024-07-01

Receive Date

2024-07-06

Publish Date

2024-07-01

Page Start

855

Page End

860

Print ISSN

1110-1121

Online ISSN

1687-7624

Link

https://ejsur.journals.ekb.eg/article_365350.html

Detail API

https://ejsur.journals.ekb.eg/service?article_code=365350

Order

365,350

Type

Original Article

Type Code

3,086

Publication Type

Journal

Publication Title

The Egyptian Journal of Surgery

Publication Link

https://ejsur.journals.ekb.eg/

MainTitle

Flexible ureteroscopy for large renal stones: Are we pushing the limits: A multi-center retrospective analysis

Details

Type

Article

Created At

21 Dec 2024