title: Ureteroscopic treatment of larger renal calculi (>2 cm).
abstract: OBJECTIVE
  To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens.
  
  
  METHODS
  We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications.
  
  
  RESULTS
  In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23-84)%, 87.1 (79-91)% and 94.4 (90.1-96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2-2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%).
  
  
  CONCLUSIONS
  UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist's options treating renal calculi of >2 cm.
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Demetrius H
authors.initials: DH
authors.lastname: Bagley
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Healy
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Nir
authors.initials: N
authors.lastname: Kleinmann
keywords: CRI, chronic renal insufficiency; Calculi; Kidney; Lithotripsy; PCNL, percutaneous nephrolithotomy; UAS, ureteric access sheath; UL, ureteroscopic lithotripsy; Ureteroscopy