title: [Combined flexible and semirigid ureteroscopy with laser lithotripsy. Alternative to percutaneous nephrolithotomy of complex EWSL refractory nephrolithiasis].
abstract: BACKGROUND
  Flexible ureteroscopic laser lithotripsy of intrarenal calculi is technically demanding and challenging due to potential dislocation from the calyx and damage to the tissue or the fiber optic during in situ laser lithotripsy.
  
  
  METHODS
  In 12 consecutive patients ESWL resistant renal stones were collected with the flexible ureteroscope using the nitinol basket and repositioned into the renal pelvis. After removing the flexible ureteroscope from the ureter the stones were treated through an additionally inserted semirigid ureteroscope with frequency-doubled double-pulse Neodym:YAG (FREDDY) laser under direct vision.
  
  
  RESULTS
  Operating time was on average 110 min. During the complication-free 3 month follow-up, 8 patients had complete success, 3 partial success, 1 patient had residual fragments>3 mm and 88% of lower pole calyces were stone-free.
  
  
  CONCLUSIONS
  As an alternative to percutaneous nephrolithotomy, repositioning of renal stones to the renal pelvis with the flexible instrument allows in selected cases safe laser fragmentation through a semirigid instrument. Access or exposition-related problems can be solved and repair costs of the instruments will be minimized.
authors.affiliation: Abteilung für Kinderurologie der Universität Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany. anne-karoline.ebert@barmherzige-regensburg.de
authors.forename: A K
authors.initials: AK
authors.lastname: Ebert
authors.forename: W
authors.initials: W
authors.lastname: Schafhauser
mesh_terms: D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D053040:Nephrolithiasis / Q000628:therapy*; D009403:Nephrostomy, Percutaneous; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*