title: Combined laparoendoscopic single-site ureterolithotomy and flexible cystoscopy in the treatment of concurrent large upper ureteral and renal stones.
abstract: OBJECTIVE
  The aim of this study was to present the authors' experience with technical recommendations for the treatment of concurrent large upper ureteral and renal stones.
  
  
  METHODS
  Between September 2014 and March 2016, laparoendoscopic single-site surgery (LESS) ureterolithotomy with renal stone extraction or holmium laser lithotripsy under flexible cystoscopy was performed on 15 patients who had concurrent upper ureteral and renal stones. The ureteral stone was treated with LESS ureterolithotomy. After the ureteral stone had been removed, a flexible cystoscope was inserted through one of the laparoscopic ports into the renal pelvis and collecting systems. Renal stones were extracted with a stone basket or broken by a holmium laser and then removed. The perioperative and postoperative data were collected and analyzed retrospectively. Patients were followed up postoperatively for evidence of long-term side-effects.
  
  
  RESULTS
  Nine patients underwent LESS ureterolithotomy and flexible cystoscope-assisted renal stone extraction. Six patients underwent concomitant holmium laser lithotripsy because of larger renal stones. All procedures were completed successfully. The ureteral stones were 15-23 mm in diameter and the renal stones were 4-20 mm in diameter. The mean surgery time was 156 min. Estimated blood loss was 70 ml. Complete stone clearance was confirmed by postoperative imaging in all patients. The median length of hospital stay after surgery was 9.1 days. No intraoperative or postoperative complications occurred during a mean follow-up of 10.2 months.
  
  
  CONCLUSIONS
  LESS ureterolithotomy with renal stone extraction or holmium laser lithotripsy under flexible cystoscopy can be considered an effective treatment for patients with concurrent large ureteral and renal stones.
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Jian
authors.initials: J
authors.lastname: Su
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Lin
authors.initials: L
authors.lastname: Yuan
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Qingling
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Wei
authors.affiliation: a Department of Urology , Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine , Nanjing , PR China.
authors.forename: Luming
authors.initials: L
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003558:Cystoscopy; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods; D053844:Lasers, Solid-State / Q000627:therapeutic use; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014514:Ureteral Calculi / Q000628:therapy*
keywords: Flexible cystoscope; laparoendoscopic single-site surgery; renal stone; upper ureteral stone; ureterolithotomy