Flexible ureteroscopy for large renal stones: Are we pushing the limits: A multi-center retrospective analysis

Document Type : Original Article

Authors

1 Department of Urology, Theodor Bilharz Research Institute, Giza

2 Thundar Bay Regional Health Science Center, Northern Ontario School of Medicine, Ontario, Canada

3 AlQassimi Hospital, EHS, Sharjah, United Arab Emirates

Abstract

Background: Managing large renal stones presents challenges. While percutaneous nephrolithotripsy (PCNL) is the gold
standard, flexible ureteroscopy (f-URS) with laser technology has emerged as a minimally invasive alternative.
Objective: To evaluate the outcomes of f-URS for renal stones larger than 20 mm in three centers and identify factors
that influence stone-free rates (SFR).
Patients and Methods: A retrospective analysis of 423 patients who underwent f-URS with holmium laser lithotripsy
for renal stones greater than or equal to 20 mm between January 2021 and October 2023 was conducted. Data from
three centers in UAE, Canada, and Egypt were analyzed. Stone size, site, density, preoperative stenting, operative time,
postoperative complications, and SFR at 30 days were assessed. Univariate and multivariate analyses were performed to
identify factors influencing SFR.
Results: A total of 103 patients met the inclusion criteria. The median stone size was 25 mm. Preoperative stents were
inserted in around half of the cohort. Disposable f-URS and ureteral access sheath were used in the majority of patients.
Median operative time was 94 min. Postoperative complications occurred in 21%. Significant residual fragments were
assessed 30 days postoperatively, around 50% of the study cohort required auxiliary procedures. Univariate analysis
revealed no significant associations between SFR and stone size, location, number, density, or preoperative stenting.
Conclusion: In this multi-center study, f-URS with holmium laser lithotripsy could not achieve decent early stone-free
rates for large renal stones, further research is needed to optimize treatment strategies for large renal stones.

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