title: Extracorporeal lithotripsy endoscopically controlled by ureterorenoscopy (LECURS): a new concept for the treatment of kidney stones-first clinical experience using digital ureterorenoscopes.
abstract: OBJECTIVE
  To evaluate the feasibility and usefulness of extracorporeal lithotripsy endoscopically controlled by simultaneous flexible ureterorenoscopy (LECURS) and combined with Holmium laser lithotripsy for kidney stones surgery.
  
  
  METHODS
  Retrograde flexible ureteroscopy allowed stone visualization and intrarenal relocation when possible. Extracorporeal schock wave lithotripsy (ESWL) was performed under direct vision allowing constant focal zone adjustment for optimal stone fragmentation. Holmium laser lithotripsy was used simultaneously when necessary. Post-operative assessment included ultrasound at day one and abdominal CT scan 3 weeks later to evaluate for residual fragments.
  
  
  RESULTS
  Six patients with kidney stones were recruited including 3 with relative contraindication to ESWL. One patient had a stone beyond an infundibular stenosis and 2 had multiple stones in a horseshoe kidney with an uretero-pelvic junction (UPJ) stricture. A 100 % stone fragmentation rate was obtained. Post-operative ultrasound was normal in 5 patients and showed slight peri-renal infiltration in the other. One patient developed an obstructive pyelonephritis requiring antibiotics and changing a double J to a ureteral catheter. No other complications were noted. Three patients (50 %) were stone free after LECURS. Three patients underwent a second-look procedure for small (<3 mm) retained residual fragments. No damage was seen with the digital ureteroscopes, laser fibers or stone baskets.
  
  
  CONCLUSIONS
  This initial experience with LECURS has shown to be feasible and safe. This opens the opportunity for further evaluation of this approach in order to improve outcomes of both approaches.
authors.affiliation: Urology Department, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, Paris Cedex 20, 75970, France, olivier.traxer@tnn.aphp.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.forename: Julien
authors.initials: J
authors.lastname: Letendre
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007669:Kidney Calculi / Q000175:diagnosis / Q000628:therapy*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D014567:Urography
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