Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract

Kozyrakis,Diomidis; Soukias,Georgios; Karagiannis,Dimitrios; Zarkadas,Anastasios; Perikleous,Stefanos; Chatzistamou,Styliani-Elissavet; Katsaros,Ilias; Skriapas,Konstantinos; Lardas,Michael; Mertziotis,Nikolaos; Kratiras,Zisis

doi:10.3892/etm.2022.11221

April-2022 Volume 23 Issue 4

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

April-2022 Volume 23 Issue 4

Full Size Image

Article

Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract

Authors:
- Diomidis Kozyrakis
- Georgios Soukias
- Dimitrios Karagiannis
- Anastasios Zarkadas
- Stefanos Perikleous
- Styliani-Elissavet Chatzistamou
- Ilias Katsaros
- Konstantinos Skriapas
- Michael Lardas
- Nikolaos Mertziotis
- Zisis Kratiras
View Affiliations / Copyright

Affiliations: Department of Urology, ‘Achillopoulio’ General Hospital, Volos 32222, Greece, Department of Urology, General Hospital of Larisa, Larisa 41447, Greece, Department of Urology, ‘Metropolitan’ General Hospital, Athens 15562, Greece
Article Number: 294
|
Published online on: February 17, 2022

https://doi.org/10.3892/etm.2022.11221
Expand metrics +

Abstract

Treatment of large and multiple stones located in the ureter and/or the kidney may be challenging. The aim of the current study was to evaluate the results and complications of retrograde endoscopic lithotripsy for stones located in the urinary tract and to determine prognostic factors for treatment outcome. From April 2017 to March 2020, eligible patients for the active treatment of ureterolithiasis with or without concomitant nephrolithiasis <20 mm were enrolled in the study. The prognostic factors for the stone free rate (SFR) after the 1st and subsequent sessions and overall complications were assessed. Patients were divided into single or multiple lithiasis groups (groups A and B respectively). A comparison between these two groups was then conducted. Overall, 237 stones were detected in 155 patients, representing a mean burden of 1.53 stone per patient. The mean total stone size was 14.7 mm, the initial SFR was 80% and the final SFR (after a mean of 1.23 session per patient) was 94.2%. The rate of complications was 26.4%. Multivariative analysis revealed that preoperative stenting and total stone size were independent prognostic factors of initial SFR, while no independent factors were determined for final SFR. Age, total size and stones in the lower calyx were independent factors for complications. In group A and B, 114 and 41 cases with solitary and multiple stones were included, respectively. Excluding operation time (P=0.002), no significant differences were recorded in terms of initial (P=0.255) and final SFR (P=0.056), hospital stay (P=0.308), mean number of treatments (P=0.757) and the rate of complications (P=0.218) between the two groups. In conclusion, retrograde endoscopic management of multiple lithiasis has a favorable outcome irrespective of stone location. Older patients with higher burdens and stones in the lower calyx should be treated with caution.

View Figures

View References

1	Bagley D: Expanding role of ureteroscopy and laser lithotripsy for treatment of proximal ureteral and intrarenal calculi. Curr Opin Urol. 12:277–280. 2002.PubMed/NCBI View Article : Google Scholar
2	Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR and de la Rosette JJ: CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: The clinical research office of the endourological society ureteroscopy global study. Eur Urol. 66:102–109. 2014.PubMed/NCBI View Article : Google Scholar
3	Turk C, Skolarikos A, Neisius A, Petrik A, Seitz C and Thomas K: Guidelines Associates. Donaldson JF, Drake T, Grivas N and Ruhayel Y: EAU Guidelines on Urolithiasis. Available from: http://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2019-large-text.pdf.
4	Assimos D, Krambeck A, Miller NL, et al: Surgical Management of Stones. AUA/Endourological Society Guideline 2016 accessed in https://www.auanet.org/guidelines/kidney-stones-surgical-management-guideline.
5	Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X and Jiang R: Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta-analysis. Exp Ther Med. 18:1366–1374. 2019.PubMed/NCBI View Article : Google Scholar
6	Hyams ES, Munver R, Bird VG, Uberoi J and Shah O: 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. 24:1583–1588. 2010.PubMed/NCBI View Article : Google Scholar
7	Xu C, Song RJ, Jiang MJ, Qin C, Wang XL and Zhang W: Flexible ureteroscopy with holmium laser lithotripsy: A new choice for intrarenal stone patients. Urol Int. 94:93–98. 2015.PubMed/NCBI View Article : Google Scholar
8	Takazawa R, Kitayama S and Tsujii T: Single-session ureteroscopy with holmium laser lithotripsy for multiple stones. Int J Urol. 19:1118–1121. 2012.PubMed/NCBI View Article : Google Scholar
9	Alkan E, Ozkanli O, Avci E, Turan M, Başar MM, Acar O and Balbay MD: Effectiveness of flexible ureterorenoscopy and laser lithotripsy for multiple unilateral intrarenal stones smaller than 2 cm. Adv Urol. 2014(314954)2014.PubMed/NCBI View Article : Google Scholar
10	Breda A, Ogunyemi O, Leppert JT and Schulam PG: Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol. 55:1190–1196. 2009.PubMed/NCBI View Article : Google Scholar
11	Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, et al: The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg. 250:187–196. 2009.PubMed/NCBI View Article : Google Scholar
12	Ozgor F, Kucuktopcu O, Ucpinar B, Gurbuz ZG, Sarilar O, Berberoglu AY, Baykal M and Binbay M: Is there a difference between presence of single stone and multiple stones in flexible ureterorenoscopy and laser lithotripsy for renal stone burden <300 mm2? Int Braz J Urol. 42:1168–1177. 2016.PubMed/NCBI View Article : Google Scholar
13	Lawler AC, Ghiraldi EM, Tong C and Friedlander JI: Extracorporeal shock wave therapy: Current perspectives and future directions. Curr Urol Rep. 18(25)2017.PubMed/NCBI View Article : Google Scholar
14	Herrera-Gonzalez G, Netsch C, Oberhagemann K, Bach T and Gross AJ: Effectiveness of single flexible ureteroscopy for multiple renal calculi. J Endourol. 25:431–435. 2011.PubMed/NCBI View Article : Google Scholar
15	Lai D, Chen M, He Y and Li X: Simultaneous retrograde intrarenal surgery for ipsilateral asymptomatic renal stones in patients with ureteroscopic symptomatic ureteral stone removal. BMC Urol. 15(22)2015.PubMed/NCBI View Article : Google Scholar
16	Lee SH, Kim TH, Myung SC, Moon YT, Kim KD, Kim JH, Kwon JK and Chang IH: Effectiveness of flexible ureteroscopic stone removal for treating ureteral and ipsilateral renal stones: A single-center experience. Korean J Urol. 54:377–382. 2013.PubMed/NCBI View Article : Google Scholar
17	Loftus CJ, Ganesan V, Traxer O, Schold JD, Noble M, Sivalingam S, Muruve N and Monga M: Ureteral wall injury with ureteral access sheaths: A randomized prospective trial. J Endourol. 34:932–936. 2020.PubMed/NCBI View Article : Google Scholar

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract

This article is mentioned in:

Abstract

Related Articles