[The value of retrograde ureterorenoscopy in the treatment of bulky kidney calculi].
OBJECTIVE
To assess the value of retrograde endoscopic lithotripsy for very large pyelocaliceal stones.


METHODS
Eighteen patients between the ages of 28 and 80 years (mean : 52) and presenting a staghorn renal calculus (n = 7) or with a maximal diameter greater than or equal to 20 mm (n = 11) were initially managed by rigid or flexible retrograde ureterorenoscopy, with ballistic (Lithoclast) or electrohydraulic (Riwolith) stone fragmentation. In 16 cases (89%), an additional extracorporeal shock-wave lithotripsy (ESWL) session was performed immediately after the endoscopic procedure. Early complications consisted of 3 cases of bacteraemic discharge rapîdly responding to medical treatment and 1 death from septic shock on the 8th postoperative day. Twelve patients (67%) were subsequently treated by ureteroscopy (n = 4) or ESWL (n = 11).


RESULTS
17 patients were evaluated after this therapeutic procedure, with a follow-up of 3 to 6 months (mean : 4). Stone elimination was complete for 8 patients (47%), 3 of whom initially presented a staghorn calculus. A residual stone was observed in 9 cases (53%), with a maximal diameter < 5 mm in 7 cases (41%). One patient (5%) underwent secondary percutaneous nephrolithotomy.


CONCLUSIONS
Technological progress has clearly facilitated the ureteroscopic approach to very large pyelocaliceal stones, but fragmentation and stone elimination remain problematical. This unconventional approach constitutes a potential field of technical progress, but does not represent a really efficient alternative to PCNL at the present time.
Robert
M
M
Service d'Urologie I, Hôpital Lapeyronie, Montpellier, France.
Drianno
N
N
Marotta
J
J
Delbos
O
O
Guiter
J
J
Grasset
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology; D002423:Cause of Death; D004724:Endoscopy; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney; D007669:Kidney Calculi / Q000473:pathology / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012772:Shock, Septic / Q000209:etiology; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods