title: [Flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in neurologic patients with severe motor disability].
abstract: OBJECTIVE
  The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability.
  
  
  METHODS
  Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system.
  
  
  RESULTS
  Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo>2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases.
  
  
  CONCLUSIONS
  Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted.
  
  
  METHODS
  5.
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. Electronic address: madecfx@hotmail.com.
authors.forename: F-X
authors.initials: FX
authors.lastname: Madec
authors.affiliation: Service de chirurgie pédiatrique département urologique, hôpital Mère-Enfant, CHU de Nantes, 44093 Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Suply
authors.affiliation: Service d'urologie, hôpital La-Roche-sur-Yon, CHD Vendée, Les Oudairies, boulevard Stéphane-Moreau, 85925 La-Roche-sur-Yon, France.
authors.forename: F
authors.initials: F
authors.lastname: Luyckx
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: M
authors.initials: M
authors.lastname: Nedelec
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Chowaniec
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: J
authors.initials: J
authors.lastname: Branchereau
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: L
authors.initials: L
authors.lastname: Le Normand
authors.affiliation: Service d'urologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
authors.forename: P
authors.initials: P
authors.lastname: Glemain
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000209:etiology* / Q000628:therapy*; D017602:Lithotripsy, Laser; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014514:Ureteral Calculi / Q000209:etiology* / Q000628:therapy*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000295:instrumentation*
keywords: Blessé médullaire; Calcul du haut appareil urinaire; Flexible ureteroscopy; Fragments résiduels; Spinal cord injury; Stone free; Urolithiasis; Urétérorénoscopie souple