The effectiveness of retrograde endoscopic interventions in the treatment of large kidney stones and staghorn nephrolithiasis

Merinov D.S., Fatihov R.R., Arustamov L.D., Pavlov D.A.

The purpose of the study – a synthesis and analysis of experience with transurethral endoscopic techniques in patients with large renal stones and staghorn nephrolithiasis.

Materials and Methods: Between February 2009 and present time 34 patients with large renal stones and staghorn nephrolythiasis underwent a transurethral laser pyelocalicotripsy at the Research Institute of Urology. The average size of stones was 4.5 cm. In all patients we used hydrophilic ureteral shell 14/16 Ch, 35 cm. Stone destruction was carried out using rigid mini-ureteroscope 8,5 Ch, fibro-ureteroscope 7,5 Ch, holmium laser 50 watt under the fluoroscopy control. Extraction of stones was performed using nitinol baskets. After surgery, kidney was drained by double- J stent for a month. Follow-up was conducted 1 month after surgery.

Results: At follow-up examination in 77% of patients clinically significant residual stone fragments were absent. 28% of patients underwent 8 sessions of ESWL on the residual stones. In 14% ESWL was ineffective, repeated fibrocalycolithoextraction was performed. In 7 (21%) cases, low efficacy of transurethral pyelocalycolithotripsy was due to inability to bring ereteral shell up to uretero-pelvic junction. The most significant complication - recrudescence of chronic pyelonephritis was observed in 23% of patients.

Conclusion: Transurethral contact laser pyelocalycolithotripsy using hydrophilic ureteral shell is sufficiently effective and safe treatment for staghorn kidney stones. Lower risk of complications is a reasonable alternative method for percutaneous interventions in patients with staghorn nephrolithiasis. 

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