title: Alternative management of complex renal stones.
abstract: BACKGROUND
  The gold standard for treatment of large and complex renal stones is percutaneous nephrolithotomy (PCNL). However, in patients with significant comorbididties, this option may be suboptimal. We reviewed our experiences with ureterorenoscopy and Holmium laser lithotripsy (UL) for the primary management of large and complex intrarenal calculi.
  
  
  METHODS
  Forty-three patients with large (2 cm or greater in diameter) renal or staghorn calculi were treated with primary UL. Seven patients were morbidly obese, three had solitary kidneys, two had horseshoe kidneys, three had hepatitis C virus, and three were self-pay and refused admission to the hospital. We calculated the total amount of stone burden, location and composition of calculi, number or ureterorenoscopic procedures necessary, and operative time.
  
  
  RESULTS
  In 42/44 renal units (95.5%), complete ureterorenoscopic fragmentation of the stone burden was accomplished. The mean number of procedures necessary to clear all stone burden was 2.07 (range 1-5). The mean stone size was 3.63 cm (range 2-9 cm). The mean operative time was 107.4 min per procedure (range 30-230 min). Two patients were treatment failures and required intervention following ureteroscopy. In both, SWL cleared the remaining stone burden. No patient required PCNL, and one patient was admitted for urosepsis.
  
  
  CONCLUSIONS
  This series demonstrates that ureterorenoscopy and Holmium laser lithotripsy is an effective and safe primary treatment modality for the treatment of large complex kidney stones. It is an attractive alternative to PCNL, particularly in those with comorbid conditions.
authors.affiliation: Department of Urology, Center for Kidney Stone Disease, Georgetown University/Washington Hospital Center, 3800 Reservoir Road, NW, 1 PHC, Washington, DC 20007-2197, USA.
authors.forename: Millie
authors.initials: M
authors.lastname: Pevzner
authors.forename: Brian C
authors.initials: BC
authors.lastname: Stisser
authors.forename: Jordan
authors.initials: J
authors.lastname: Luskin
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Yeamans
authors.forename: Marina
authors.initials: M
authors.lastname: Cheng-Lucey
authors.forename: John J
authors.initials: JJ
authors.lastname: Pahira
mesh_terms: D005260:Female; D006695:Holmium; D006801:Humans; D007669:Kidney Calculi / Q000473:pathology* / Q000601:surgery*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*
chemical_list: D006695:Holmium