Téma: Overview works

Flexible ureterorenoscopy in the treatment of upper urinary tract calculi

Michal Fedorko

Objective: to assess the role of flexible ureterorenoscopy in the treatment of ureteral and renal calculi, as well as provide complex data on available instruments and accessories, their features and contemporary operative technique, based on recent knowledge obtained by systematic review of the literature and current guidelines. Methods: data on flexible ureterorenoscopy were analyzed using Medline with emphasis on recent publications from 2006-2009 related to flexible ureterorenoscopes, accessories, primary and secondary treatment outcomes and advances in operative technique. Results: The new-generation flexible ureteroscopes are able to access all renal calyces even with instruments inserted. Lower calyx access is influenced by anatomical factors. Laser fiber has major impact on properties and lifetime of the instrument. Digital flexible ureterorenoscope provides better image quality. Ureteral access sheath allows safe access to the upper urinary tract, lowers intrarenal pressure and does not increase complication rate. Ho:YAG laser is the ideal lithotripter. Stone-free rate for ureteral calculi reaches 95 % after the procedure. Stone-free rate for renal calculi < 1.5 cm is 50-95 %. Stone-free rates are higher in primary than in secondary procedures. Complications occur in 5-9 % with significant complications < 1 %. Bilateral procedure is safe for certain group of patients. Combination with PNL decreases the number of percutaneuos approaches and morbidity. Conclusions: Flexible ureterorenoscopy with laser lithotripsy may be considered as a first-line treatment in some centers for intrarenal calculi ≤ 15 mm, with a particular value in obese patients or those with a bleeding diathesis. Flexible ureterorenoscopy is an effective treatment for residual stones after ESWL or PNL. It may be successfully combined with other treatment modalities. Both retrograde and antegrade flexible ureteroscopy may be effectively used in the treatment of proximal ureteral calculi.

Ročník 2009  Témy časopisu Clinical urology 1 / 2009

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