title: Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.
abstract: OBJECTIVE
  This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm.
  
  
  METHODS
  This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance.
  
  
  RESULTS
  Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA <30° was a negative risk factor (p=0.019). Postoperative complications occurred in nine patients (13.4%), including Clavien grade I complications in two patients (2.9%), grade II in six patients (8.9%), and grade IIIa in one patient (1.8%). Almost all complications were minor.
  
  
  CONCLUSIONS
  An IPA <30° is the only negative risk factor for stone clearance after fURSL for large renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.
authors: 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan .
authors: Takaaki
authors: T
authors: Inoue
authors: 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan .
authors: Takashi
authors: T
authors: Murota
authors: 2 Department of Urology, Gyotoku General Hospital , Ichikawa City, Japan .
authors: Shinsuke
authors: S
authors: Okada
authors: 3 Department of Urology, Toyota Kousei Hospital , Toyota City, Japan .
authors: Shuzo
authors: S
authors: Hamamoto
authors: 1 Department of Urology and Stone Center, Takii Hospital, Kansai Medical University , Moriguchi City, Japan .
authors: Kouei
authors: K
authors: Muguruma
authors: 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan .
authors: Hidefumi
authors: H
authors: Kinoshita
authors: 4 Department of Urology, Hirakata Hospital, Kansai Medical University , Hirakata City, Japan .
authors: Tadashi
authors: T
authors: Matsuda
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000601:surgery*; D007682:Kidney Pelvis / Q000033:anatomy & histology / Q000601:surgery; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D059035:Perioperative Period; D011183:Postoperative Complications / Q000601:surgery; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000379:methods*; D055815:Young Adult