title: Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era.
abstract: Large renal stones (>2 cm) are managed with percutaneous nephrolithotomy (PCNL), which has a good stone-free rate (SFR) but a relatively high incidence of complications graded Clavien ≥ 3. We wanted to review the literature for the use of ureterorenoscopy and laser fragmentation (URSL) for the management of these stones. A systematic review was done from 1990 to April 2014 for all English language articles reporting on a minimum of 10 patients for stones >2 cm in size (done by 2 reviewers independently) in accordance with the PRISMA and Cochrane review guidelines. A total of 379 articles were identified and after screening for the titles (54) and abstracts (29), 12 papers (651 patients) were included. The male to female ratio was 356:232 with a mean age of 54 years (range 16-86 years). With a mean stone size of 2.7 cm (2-3.15 cm) and the mean operating time of 96 min (28-238 min); the SFR was 91 % (1.45 procedures/patient). The overall number of complications was 58 (8.6 %) of which 26 (4.5 %) were complications classed Clavien ≥ 3 (haematuria with subcapsular haematoma/clot retention-7; ureteral perforation-7; steinstrasse-5; sepsis/pyelonephritis-5; prostatitis-1; cerebrovascular accident-1). Ureterorenoscopy for large renal stones in the modern era has good SFR with a small risk of major complications.
authors.affiliation: Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Geraghty
authors.forename: Omar
authors.initials: O
authors.lastname: Abourmarzouk
authors.forename: Bhavan
authors.initials: B
authors.lastname: Rai
authors.forename: Chandra Shakhar
authors.initials: CS
authors.lastname: Biyani
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Rukin
authors.forename: Bhaskar K
authors.initials: BK
authors.lastname: Somani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007834:Lasers; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D018666:Ureteroscopy; D016055:Urinary Retention; D055815:Young Adult