Transurethral lithotripsy with rigid and flexible ureteroscopy for renal and ureteral stones: results of the first 100 procedures

We evaluated the clinical outcome of transurethral lithotripsy (TUL) using rigid & flexible ureteroscopy and holmium : yttrium-aluminum-garnet (YAG) laser in our hospital. We retrospectively reviewed 100 consecutive transurethral lithotripsy procedures performed on 82 patients from May 2008 to June 2010 at our hospital. Twenty-five patients (30%) had multiple stones and 10 patients (12%) had bilateral stones. The main stones were located in the renal pelvis, ureteropelvic junction, upper ureter, middle ureter, and lower ureter in 14, 12, 26, 3, and 27 cases, respectively. Median operative time was 75 minutes (range, 18-238 minutes). Operative complications were 5 cases of pyelonephritis and 1 case of ureteral perforation that was managed conservatively with percutaneous nephrostomy. The average number of procedures was 1.22 with 65 patients requiring one, 16 requiring two, and 1 requiring three procedures. Three patients had shock wave lithotripsy (SWL) and two patients had minipercutaneous nephrolithotomy (mini-PNL) after first TUL. However, all of these patients eventually needed additional TUL. The overall success rate was 99% (81/82). Rigid & flexible ureteroscopy and holmium : YAG laser lithotripsy achieved excellent results of treatment for urolithiasis. TUL gave a high stone-free rate with low complication rates. In Japan, where shock wave lithotripters are widely used, trend of treatment for urolithiasis will shift from SWL to TUL.