title: Second-look Flexible Nephroscopy Combined With Holmium: Yttrium-Aluminum-Garnet Laser Lithotripsy Under Local Anesthesia: A Prospective Study.
abstract: OBJECTIVE
  To present a prospectively studied series of patients who underwent second-look flexible nephroscopy combined with holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy under local anesthesia for residual stone removal after percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Thirty consecutive eligible patients who underwent a PCNL procedure in the previous 48-96 hours were included. The inclusion criteria were the following: (1) 1 or 2 residual stones 0.8-1.5 cm in diameter and (2) age >18 years. Approximately 15 mL of a 2% solution of lidocaine hydrochloride was injected through the nephrostomy tube, which was then clamped for 15 minutes. Flexible nephroscopy was combined with Ho:YAG laser lithotripsy set at 0.8 Joules and 8 Hz. Patients were asked to rate their pain intensity using the numeric rating scale (NRS).
  
  
  RESULTS
  There were 14 (46.7%) men and 16 (53.3%) women in the study, with a mean age of 45.2 ± 17.5 years. Twenty-one (70%) patients had 1 stone and 9 (30%) had 2 stones needing fragmentation. Twenty-eight (93.3%) patients successfully underwent the procedure under local anesthesia. The mean NRS value was 1.39 ± 1.08 (range 0-5). For the entire group, there was a statistically significant difference between those patients with 1 stone vs 2 stones needing fragmentation (NRS scores of 1.1 ± 0.77 vs 2.1 ± 1.36, respectively, P = .033). Operative time >30 minutes was associated with higher NRS score. The stone-free rate under local anesthesia was 86.7%.
  
  
  CONCLUSIONS
  For patients with a minimal to moderate residual stone burden after PCNL, second-look flexible nephroscopy can be combined with Ho:YAG laser lithotripsy using only local anesthesia.
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: stgian@otenet.gr.
authors.forename: Stilianos
authors.initials: S
authors.lastname: Giannakopoulos
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Giannopoulos
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Gardikis
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Bantis
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Kalaitzis
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Zissimopoulos
authors.affiliation: Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Touloupidis
mesh_terms: D000535:Aluminum; D000772:Anesthesia, Local / Q000379:methods*; D005260:Female; D006695:Holmium; D006801:Humans; D007669:Kidney Calculi / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000379:methods*; D018666:Ureteroscopy / Q000379:methods; D015019:Yttrium
chemical_list: C503779:yttrium-aluminum-garnet; D015019:Yttrium; D000535:Aluminum; D006695:Holmium