title: Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones.
  
  
  METHODS
  Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II).
  
  
  RESULTS
  Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p < 0.001). Flexible ureteroscopic therapy for renal calculi increased 18 minutes in the mean operative time. The overall complication rate was 3.1% and 2.5% for groups I and II, respectively (p = 0.87). Mean renal stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01).
  
  
  CONCLUSIONS
  Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.
authors.affiliation: Department of Urology, University of Sao Paulo (USP), Sao Paulo, Brazil. mcocuzza@uol.com.br
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Jose R
authors.initials: JR
authors.lastname: Colombo
authors.forename: Arvind
authors.initials: A
authors.lastname: Ganpule
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.forename: Antonio
authors.initials: A
authors.lastname: Cocuzza
authors.forename: Divyar
authors.initials: D
authors.lastname: Dhawan
authors.forename: Bruno
authors.initials: B
authors.lastname: Santos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.forename: Mahesh
authors.initials: M
authors.lastname: Desai
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
mesh_terms: D000328:Adult; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000150:complications* / Q000601:surgery*; D053844:Lasers, Solid-State / Q000009:adverse effects; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018583:Pliability; D014514:Ureteral Calculi / Q000150:complications* / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods*