Document Detail


Combined ureterorenoscopy and shockwave lithotripsy for large renal stone burden: an alternative to percutaneous nephrolithotomy?
MedLine Citation:
PMID:  15910257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To investigate the feasibility and initial outcomes of a combination of ureterorenoscopy (URS) using holmium laser lithotripsy and extracorporeal shockwave lithotripsy (SWL) in a single outpatient session for the treatment of large renal stone burdens in patients refusing or unsuitable for percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Fourteen patients with a mean age of 52.7 years (range 34-81 years) having a mean stone burden of 847 mm2 (range 58 mm2-1850 mm2) were treated with combined URS laser lithotripsy and SWL as an alternative to PCNL. The SWL (mean 2800 shockwaves) was performed using the Storz Modulith SL-X, and flexible URS with holmium laser lithotripsy was performed either during or following SWL. RESULTS: Ninety-three percent of the patients (13/14) were treated successfully on an outpatient basis. Two patients were rendered stone free after the initial procedure alone (14%). Overall, including secondary outpatient treatment with a second session of URS alone (N = 7) URS and SWL (N = 1), SWL (N = 1), or oral alkalinization therapy (N = 1), the stone-free rate was 76.9% (10/13). One patient was excluded secondary to death from unrelated causes after the initial procedure, and the success rate (residual fragments <4 mm) was 84.6% (11/13). The two treatment failures included one patient who required a third URS procedure and one patient who developed urosepsis necessitating nephrostomy-tube placement who underwent subsequent PCNL. CONCLUSIONS: In comparison with traditional approaches using PCNL and second-look nephroscopy, single-session combined URS and SWL with a second outpatient procedure may offer equivalent results with decreased morbidity in carefully selected patients.
Authors:
Jason Hafron; James D Fogarty; Judd Boczko; David M Hoenig
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  19     ISSN:  0892-7790     ISO Abbreviation:  J. Endourol.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-05-24     Completed Date:  2005-10-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-8     Citation Subset:  IM    
Affiliation:
Department of Urology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ambulatory Care
Feasibility Studies
Female
Humans
Kidney Calculi / therapy*
Lithotripsy, Laser / methods*
Male
Middle Aged
Nephrostomy, Percutaneous
Patient Selection
Retreatment
Treatment Outcome
Ureteroscopy / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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