title: Retrograde intrarenal lithotripsy outcome after failure of shock wave lithotripsy.
abstract: OBJECTIVE
  We report our experience with retrograde intrarenal lithotripsy (RIRL) for renal stones not alleviated by shock wave lithotripsy (SWL).
  
  
  METHODS
  A total of 28 females and 53 males with a mean age of 53 years (range 18 to 86) were studied. They had been treated with a mean of 3.2 previous SWLs. Mean stone size was 9.2 mm (range 4 to 22) and the mean number of stones per patient was 1.27 (range 1 to 5) for a total of 103 stones overall. In 70 patients there was 1 stone. Rigid and flexible ureteroscopes were used in 8 and 67 cases, respectively, while a combined approach was used in 6. A holmium:YAG laser was used for fragmentation in 52 patients. Success was defined as stone-free status or residual fragments less than 3 mm.
  
  
  RESULTS
  The overall success rate was 67%. RIRL yielded a 46% stone-free rate. Of the 44 patients 17 (39%) had residual stones less than 3 mm, while 13 required ancillary procedures. There were no residual ureteral stones. Original stone size correlated inversely with the success rate. Most failures involved lower pole stones, in that laser fiber deflection prevented reaching them in 9 cases. The procedure was interrupted due to extravasation or bleeding in 5 patients and 6 had postoperative urinary tract infections (16% overall complication rate).
  
  
  CONCLUSIONS
  RIRL effectively and safely alleviated upper tract stones unresponsive to earlier SWL. It can be considered salvage therapy in such cases. RIRL is well suited for treating stones less than 2 cm with better stone-free rates than SWL in the same circumstances. Residual stones were more likely in lower pole cases.
authors.affiliation: Department of Urology, Assaf Harofeh Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
authors.forename: Kobi
authors.initials: K
authors.lastname: Stav
authors.forename: Amir
authors.initials: A
authors.lastname: Cooper
authors.forename: Amnon
authors.initials: A
authors.lastname: Zisman
authors.forename: Dan
authors.initials: D
authors.lastname: Leibovici
authors.forename: Arie
authors.initials: A
authors.lastname: Lindner
authors.forename: Yoram I
authors.initials: YI
authors.lastname: Siegel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D017211:Treatment Failure; D018666:Ureteroscopy