title: [RIRS through semi-rigid ureteroscope and holmium laser in the treatment of ureteral stones retropulsion].
abstract: Retrograde displacement of ureteral stones into the renal cavities during ureteroscopic lithotripsy represents a frequent and adverse event that leads to additional procedures (ESWL, PCNL, Retrograde Intra-renal lithotripsy with flexible instruments, DJ stent placement and subsequent EWSL) to obtain full clearence of calculi. All these procedures require a further time of treatment. Between 1/2008 and 3/2009, a total of 48 patients harbouring proximal (21 cases) and distal (27 cases) ureteral stones underwent Holmium Laser lithotripsy. In 3 patients previous percutaneous nephrostomy was performed to drain the excretory way. In 12 cases (25%) stone retropulsion occurred; in 3 patients in the upper calix and in 5 in the renal pelvis. Only in 4 cases the stone migrated in the lower or medium calix. In 8 cases we attempted the immediate treatment of intrarenal displaced stones by advancing the semi-rigid instrument into the renal cavities. In 2 cases the treatment aborted because of the shortness of ureteroscope. The instillation of lubricating lidocaine jelly prevented in 3 cases furher displacement of stone. Washing with saline solution through nephrostomic catheter allowed an effective mobilization of stone and an easy lasertripsy. RIRS was successful in 4 cases. When flexible devices or immediate ESWL are not available, rigid or semi-rigid retrograde lithotripsy with holmium laser immediately performed after ureteral stone displacement represents a safe and effective method to treat displaced stones. Several tricks are required to obtain a good stone-free rate.
authors.affiliation: UO Urologia, Azienda Ospedaliera Ospedale Treviglio-Caravaggio (Bergamo), Italy. micheleruoppolo@tiscalinet.it
authors.forename: M
authors.initials: M
authors.lastname: Ruoppolo
authors.forename: R
authors.initials: R
authors.lastname: Milesi
authors.forename: M
authors.initials: M
authors.lastname: Gozo
authors.forename: G
authors.initials: G
authors.lastname: Fragapane
mesh_terms: D004630:Emergencies; D005782:Gels; D006801:Humans; D007322:Instillation, Drug; D007670:Kidney Calices; D007682:Kidney Pelvis / Q000601:surgery; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008012:Lidocaine / Q000008:administration & dosage; D017602:Lithotripsy, Laser / Q000295:instrumentation* / Q000379:methods; D009403:Nephrostomy, Percutaneous; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D014514:Ureteral Calculi / Q000628:therapy*; D020709:Ureteroscopes
chemical_list: D005782:Gels; D008012:Lidocaine