title: Flexible ureteroscopy and laser lithotripsy for bilateral multiple intrarenal stones: is this a valuable choice?
abstract: OBJECTIVE
  To demonstrate the safety and efficacy of flexible ureteroscopy (FURS) and holmium laser lithotripsy as a valuable treatment of bilateral multiple intrarenal stones and stratify the efficacy by stone burdens ≤ 20 and >20 mm.
  
  
  METHODS
  Twenty-five patients with bilateral multiple intrarenal stones were treated with FURS and holmium lithotripsy at a single clinic. The operative time, stone-free rates (SFRs) per renal unit, stone compositions, number of procedures, serum creatinine, and complications were evaluated. The SFRs were evaluated with computed tomography and plain X-rays of the kidneys, ureters, and bladder. Renal ultrasound was performed 30 days after double-J stent removal to identify hydronephrosis and absence of stones. We defined a stone-free status as the absence of fragments in the kidney or fragments of <1 mm.
  
  
  RESULTS
  The total stone number was 128 with a mean stone burden per patient of 24 ± 5 (range 17-37 mm). The overall SFRs per renal unit after 1, 2, and 3 procedures were 70.0%, 92.0%, and 92.0%, respectively. The overall SFRs per renal unit for patients with a preoperative stone burden ≤ 20 and >20 mm were 100% and 85.7%, respectively. No major intraoperative or postoperative complications occurred. There were only 4 minor postoperative complications (16%).
  
  
  CONCLUSIONS
  Our study results firmly suggest that FURS with holmium laser lithotripsy represents a favorable alternative to external shock wave lithotripsy or percutaneous nephrolithotomy for select patients with bilateral multiple intrarenal stones, which have a satisfactory efficacy and low morbidity.
authors: Department of Urology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors: Zhichao
authors: Z
authors: Huang
authors: Fajun
authors: F
authors: Fu
authors: Zhaohui
authors: Z
authors: Zhong
authors: Lei
authors: L
authors: Zhang
authors: Ran
authors: R
authors: Xu
authors: Xiaokun
authors: X
authors: Zhao
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000000981:diagnostic imaging / Q000628:therapy*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D003404:Creatinine