title: Comparison of the efficacy and morbidity of flexible ureterorenoscopy for lower pole stones compared with other renal locations.
abstract: OBJECTIVE
  Flexible ureterorenoscopy (f-URS) for lower pole stones (LPS) compared with other renal locations can be challenging because of anatomic and technical considerations. We aimed to compare the stone-free rate (SFR) and surgical complication rate with f-URS for LPS vs other renal locations.
  
  
  METHODS
  We performed a retrospective, single-center study including 371 f-URS for renal stone retrieval performed in our institution between January 2004 and December 2010. Among the 371 procedures included in this analysis, 139 were performed for stones located in a single renal location other than the lower pole (group 1), and 232 for at least one stone located in the lower pole (group 2). We compared the efficacy (SFR) and the morbidity of f-URS between the two groups. The success of the procedure was defined as a complete SFR 6 months after f-URS.
  
  
  RESULTS
  Age, sex, history of urolithiasis, body mass index, and preoperative stent placement did not differ between the two groups. No differences in stone characteristics were observed between both groups except stone size under 10 mm that was significantly higher in group 2 (P=0.018). Technical aspects of the procedure did not differ between the groups, except for more frequent use of an access sheath in group 2 (P=0.007). SFR was comparable between groups (P=0.774). The complication rate was similar in both groups, as was the severity of complications. By multivariate analysis, stone size >10 mm (P<0.0001) and multiple stone locations (P=0.001) were associated with f-URS failure, but lower pole location did not impact on SFR.
  
  
  CONCLUSIONS
  In our study, stone location, in particular LPS, did not have any impact on efficacy and morbidity of f-URS. Only multiple locations and stone size >10 mm seemed to significantly decrease the SFR, without impacting morbidity.
authors.affiliation: 1 Department of Urology and Renal Transplantation, University Hospital of Besançon , France .
authors.forename: Baptiste
authors.initials: B
authors.lastname: Jacquemet
authors.forename: Lucille
authors.initials: L
authors.lastname: Martin
authors.forename: Julie
authors.initials: J
authors.lastname: Pastori
authors.forename: Vincent
authors.initials: V
authors.lastname: Bailly
authors.forename: Guillaume
authors.initials: G
authors.lastname: Guichard
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bernardini
authors.forename: Eric
authors.initials: E
authors.lastname: Chabannes
authors.forename: Hugues
authors.initials: H
authors.lastname: Bittard
authors.forename: François
authors.initials: F
authors.lastname: Kleinclauss
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007669:Kidney Calculi / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000379:methods*