In 2000, the ureteral access sheath was introduced to the urologic practice, facilitating multiple ureteral and renal reentries during flexible ureteroscopy (URS). The advent of this sheath and the evolution of flexible endoscopic technology ushered in a new paradigm of kidney stone surgery, giving urologists the ability to manipulate previously inaccessible lower pole or very large kidney stones while minimizing ureteral trauma during their removal. Retrograde flexible ureterorenoscopy with stone lithotripsy has now become a mainstream procedure in urology operating rooms across the world. This chapter analyzes the evidence-based data available for this procedure to aid in appropriate patient selection and prediction of stone-free rates (SFRs).
After appropriate study exclusion, we identified 18 published, peer-reviewed URS studies for treatment of renal stones, totaling 1,362 patients. Multiple retrospective case series and cohort studies were identified, but only 90 of the included patients (6.6 %) were the result of prospective series with SFR calculated by strict computed tomography (CT) criteria. For all stone sizes, SFRs were variable but ranged from 53 to 86 %. Due to the lack of uniformity in outcome reporting among all studies, these rates must be considered biased and unreliable for comparative purposes. Strict CT criteria lowered SFR by ∼30–40 %, demonstrating how SFR can be falsely elevated by using imaging modalities other than CT. Overall, the development and progression of ureteroscopic technology has made this modality a promising tool in the urologist’s armamentarium. However, the majority of reported renal success rates for URS in the literature are retrospective, biased, and based on non-standardized imaging and follow-up protocols. To clarify the efficacy of this modality, future URS trials should compare matched groups while measuring cost-effectiveness, validated postoperative quality of life and pain scores, and SFR by strict CT criteria. Only by careful study design can urologists increase patient satisfaction while optimizing patient outcomes.
Kidney Stone Shock Wave Lithotripsy Renal Stone Stone Size Residual Stone
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Kourambas J, Byrne RR, Preminger GM. Does a ureteral access sheath facilitate ureteroscopy? J Urol. 2001;165:789–93.PubMedCrossRefGoogle Scholar
Elbahnasy AM, Shalhav AL, Hoenig DM, et al. Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol. 1998;159:676–82.PubMedCrossRefGoogle Scholar
Menezes P, Dickinson A, Timoney AG. Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones. BJU Int. 1999;84:257–60.PubMedCrossRefGoogle Scholar
Dasgupta P, Cynk MS, Bultitude MF, et al. Flexible ureterorenoscopy: prospective analysis of the Guy’s experience. Ann R Coll Surg Engl. 2004;86:367–70.PubMedCrossRefGoogle Scholar
Breda A, Ogunyemi O, Leppert JT, et al. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater—is this the new frontier? J Urol. 2008;179:981–4.PubMedCrossRefGoogle Scholar
Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1–2-cm) renal calculi. J Endourol. 2008;22:343–6.PubMedCrossRefGoogle Scholar
Ferrandino MN, Preminger GM. Ureteroscopic management of stones in anomalous kidneys. Arch Ital Urol Androl. 2008;80:18–20.PubMedGoogle Scholar
Lahme S, Zimmermanns V, Hochmuth A, et al. Stones of the upper urinary tract. Update on minimal-invasive endourological treatment. Arch Ital Urol Androl. 2008;80:13–7.PubMedGoogle Scholar
Sejiny M, Al-Qahtani S, Elhaous A, et al. Efficacy of flexible ureterorenoscopy with holmium laser in the management of stone-bearing caliceal diverticula. J Endourol. 2010;24:961–7.PubMedCrossRefGoogle Scholar
Desai MM, Grover R, Aron M, et al. Robotic flexible ureteroscopy for renal calculi: initial clinical experience. J Urol. 2011;186:563–8.PubMedCrossRefGoogle Scholar
Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res. 2011;40(1):87–91.PubMedCrossRefGoogle Scholar
Pearle MS, Lingeman JE, Leveillee R, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol. 2005;173:2005–9.PubMedCrossRefGoogle Scholar
Portis AJ, Rygwall R, Holtz C, et al. Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup. J Urol. 2006;175:2129–33.PubMedCrossRefGoogle Scholar
Tawfiek ER, Bagley DH. Management of upper urinary tract calculi with ureteroscopic techniques. Urology. 1999;53:25–31.PubMedCrossRefGoogle Scholar
Kourambas J, Delvecchio FC, Munver R, et al. Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi. Urology. 2000;56:935–9.PubMedCrossRefGoogle Scholar
El-Anany FG, Hammouda HM, Maghraby HA, et al. Retrograde ureteropyeloscopic holmium laser lithotripsy for large renal calculi. BJU Int. 2001;88:850–3.PubMedCrossRefGoogle Scholar
Holland R, Margel D, Livne PM, et al. Retrograde intrarenal surgery as second-line therapy yields a lower success rate. J Endourol. 2006;20:556–9.PubMedCrossRefGoogle Scholar
Hyams ES, Munver R, Bird VG, et al. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: a multi-institutional experience. J Endourol. 2010;24:1583–8.PubMedCrossRefGoogle Scholar
Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm or greater upper urinary tract and minor Staghorn calculi. J Urol. 1998;160:346–51.PubMedCrossRefGoogle Scholar
Cocuzza M, Colombo Jr JR, Cocuzza AL, et al. Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upper urinary tract calculi. Int Braz J Urol. 2008;34:143–9. discussion 149–150.PubMedCrossRefGoogle Scholar
Hollenbeck BK, Schuster TG, Faerber GJ, et al. Flexible ureteroscopy in conjunction with in situ lithotripsy for lower pole calculi. Urology. 2001;58:859–63.PubMedCrossRefGoogle Scholar
Schuster TG, Hollenbeck BK, Faerber GJ, et al. Ureteroscopic treatment of lower pole calculi: comparison of lithotripsy in situ and after displacement. J Urol. 2002;168:43–5.PubMedCrossRefGoogle Scholar
Stav K, Cooper A, Zisman A, et al. Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy. J Urol. 2003;170:2198–201.PubMedCrossRefGoogle Scholar
Smith RC, Rosenfield AT, Choe KA, et al. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology. 1995;194:789–94.PubMedGoogle Scholar
Herrera-Gonzalez G, Netsch C, Oberhagemann K, et al. Effectiveness of single flexible ureteroscopy for multiple renal calculi. J Endourol. 2011;25:431–5.PubMedCrossRefGoogle Scholar
Kuo R, Lingeman J, Leveillee R, et al. A randomized clinical trial of ureteroscopy and percutaneous nephrolithotomy for lower pole stones between 11 and 25 mm. J Endourol. 2003;17:A31.Google Scholar
Riley JM, Stearman L, Troxel S. Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol. 2009;23:1395–8.PubMedCrossRefGoogle Scholar
Sofer M, Watterson JD, Wollin TA, et al. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2002;167:31–4.PubMedCrossRefGoogle Scholar