Clinical efficacy of flexible ureteroscope combined with Holmium laser in the treatment of upper urinary calculi:a report of 63 cases

Objective To evaluate the efficacy and safety of flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi,and to analyze the influencing factors of the success rate of lithotripsy.Methods Sixty-three patients with upper urinary calculi were enrolled in the study,with the stone size ranged from 10～20 mm in diameter(14 mm in average),including 30 patients of upper ureteral calculi,6 of upper calyx calculi,5 of middle calyx calculi,4 of lower calyx calculi,12 of pelvis calculi,and 6 of multiple calyx calculi.The 220 μm Holmium laser lithotripsy was performed by flexible ureteroscope.The power of the laser was 0.8～1.5 J and frequency was 10～15 Hz.A follow-up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the result of the endoscopic nephrolithotripsy.Results The total successful pulverization rate of stone was 98.4%(61/62),and the successful rate for the lower calyx stones was 66.7%(in 2 of the 3 patients,the stone was not found during operation in one patient).The total evacuation rate of the calculi was 87.3%(55/63).For the calculi in the upper or middle pole or in the renal pelvis,the complete evacuation rate was 91.5%(54/59),which was significantly higher than that for the lower pole(25.0%).No serious complications were found,such as ureter perforation,avulsion and hemorrhage.Conclusion The flexible ureteroscope and Holmium laser lithotripsy is safe and effective for upper urinary calculi sized less than 20 mm in diameter,especially for those in the upper and middle poles and renal pelvis.