title: Ureteroscopy and holmium: YAG laser lithotripsy as emergency treatment for acute renal failure caused by impacted ureteral calculi.
abstract: OBJECTIVE
  To present our clinical outcomes in managing acute renal failure caused by impacted ureteral calculi with ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy as emergency treatment.
  
  
  METHODS
  A series of 27 patients with acute postrenal failure were treated from November 2002 to December 2005. Impacted calculi were located in bilateral ureters in 22 patients and unilateral ureters in 5 patients with a solitary or single functioning kidney. Acute renal failure was demonstrated with oliguria or anuria and a significant increase in serum creatinine and blood urea nitrogen. Patients were treated emergently with ureteroscopy and holmium:yttrium-aluminum-garnet laser lithotripsy in the hospital within 24 hours. Ureteral stenting was performed in all cases. Postoperative renal function, electrolytes, and urine volume were monitored daily for 7 days. Radiography and/or ultrasonography were performed at a follow-up visit in 4 weeks.
  
  
  RESULTS
  Ureteroscopy and laser lithotripsy were successfully performed in all patients. The mean operative time was 29.2 minutes (range 15-60). The successful fragmentation rate in the ureteroscopic procedure was 93.9% (46 of 49), and the overall stone-free rate was 88.9% (24 of 27). Shock wave lithotripsy was used in 3 patients after recovery of renal function. Of the 27 patients, 26 (96.3%) returned to normal renal function within 7 days. One patient (3.7%) had significant improvement of renal function, but it had not returned to normal at 12 weeks of follow-up. No intraoperative complications or postoperative ureteral stricture occurred.
  
  
  CONCLUSIONS
  Emergency ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy can be safely and successfully performed by skilled endourologists for acute renal failure caused by impacted ureteral calculi.
authors.affiliation: Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China. haowenj@yahoo.com
authors.forename: Haowen
authors.initials: H
authors.lastname: Jiang
authors.forename: Zhong
authors.initials: Z
authors.lastname: Wu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000535:Aluminum / Q000737:chemistry*; D001002:Anuria / Q000175:diagnosis; D003404:Creatinine / Q000097:blood; D005260:Female; D006695:Holmium; D006801:Humans; D017602:Lithotripsy, Laser / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000175:diagnosis; D051437:Renal Insufficiency / Q000150:complications / Q000628:therapy; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000379:methods; D015019:Yttrium / Q000737:chemistry*
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D003404:Creatinine; D000535:Aluminum; D006695:Holmium