Guido Giusti1, Silvia Proietti2, Luca Villa3, Jonathan Cloutier4, Marco Rosso5, Giulio Maria Gadda5, Steeve Doizi4, Nazareno Suardi5, Francesco Montorsi6, Franco Gaboardi5, Olivier Traxer4. 1. Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy. Electronic address: info@guidogiusti.it. 2. Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France. 3. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France. 4. Urology Department, Tenon Hospital, Pierre and Marie Curie University, Paris, France. 5. Urology Department, IRCCS San Raffaele Scientific Institute, Ville Turro Division, Milan, Italy. 6. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract
BACKGROUND: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. OBJECTIVE: To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. SURGICAL PROCEDURE: Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS: The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. CONCLUSIONS: The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. PATIENT SUMMARY: Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
BACKGROUND: Thanks to advancements in the endoscopic armamentarium, flexible ureteroscopy (fURS) has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. OBJECTIVE: To describe our surgical technique for fURS, step-by-step, for the treatment of renal stones and to assess its effectiveness and safety. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 316 consecutive patients who underwent fURS for renal stones at our institution between March 2014 and September 2015 was performed. SURGICAL PROCEDURE: Ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinical data were collected in a dedicated database. Intraoperative and postoperative outcomes were assessed. A descriptive statistical analysis was performed. RESULTS AND LIMITATIONS: The mean overall stone size was 16.5 ± 7.9mm. Ureteral access sheath placement was possible in 287 patients (90.8%). At 1-mo follow-up, the overall primary SFR was 79.1%; the secondary and tertiary SFRs were 89.5% and 91.5%, respectively. The mean operative time was 72.6 ± 27.5min. The mean number of procedures was 1.27. Complications were reported in 92 patients (29.1%) overall, with Clavien grade 1 in 55 patients (17.4%), grade 2 in 30 patients (9.5%), grade 3 in 6 patients (1.9%), grade 4 in 1 patient (0.3%), and grade 5 in none. The main limitation of the study was the retrospective nature. CONCLUSIONS: The fURS procedure is safe and effective for the treatment of renal stones. A staged procedure is necessary to achieve stone-free status with large calculi. PATIENT SUMMARY: Flexible ureteroscopy is an effective treatment with low complication rates for the majority of renal stones. Both the modern highly technological armamentarium and surgical know-how should be available.
Authors: Kazumi Taguchi; Manint Usawachintachit; Shuzo Hamamoto; Rei Unno; David T Tzou; Benjamin A Sherer; Yongmei Wang; Atsushi Okada; Marshall L Stoller; Takahiro Yasui; Thomas Chi Journal: J Endourol Date: 2017-08-11 Impact factor: 2.942
Authors: M Haddad; E Emiliani; Y Rouchausse; F Coste; L Berthe; S Doizi; S Buttice; B Somani; O Traxer Journal: World J Urol Date: 2017-05-30 Impact factor: 4.226
Authors: Alberto Olivero; Lorenzo Ball; Carlotta Fontaneto; Guglielmo Mantica; Paolo Bottino; Paolo Pelosi; Carlo Terrone Journal: Curr Urol Date: 2021-04-26