Ureteroscopy and Holmium:YAG Laser Lithotripsy For Upper Tract Stones in a New Urology Centre: Our Initial Experience https://doi.org/10.60787/NMJ-64-2-214

Main Article Content

Timothy Uzoma M
Onyekachi Amos Onu
Chinonso Odo
Uchenna Victor Nwadi

Keywords

kidney, ureter, stone, ureteroscopy, Holmium, Laser, Lithotripsy

Abstract

Background: To demonstrate the outcome of our initial experience in the management of upper tract stones with ureteroscopy and Holmium: YAG laser lithotripsy.


Methodology: The data of thirty-two patients who had ureteroscopy and laser lithotripsy for upper urinary tract stones at a private urology centre in Awka, Anambra State Nigeria from September 2020 to June 2022 (20months) were retrospectively studied. Their sociodemographic data, clinical symptoms, the location and size of the stones, preoperative and postoperative stent use, hospital stay, complications, and stone-clearance rates were analyzed.


Results: A total of 32 procedures were performed on 32 patients. The mean age of the patients was 44.7 ± 12.2 years. The mean stone size was 15.4 ± 6.7mm with a range of 8.0-39mm, and Hounsfield unit ranging from 233-906. The stones were on the right tract, left tract, and bilateral in 46.9%, 43.7%, and 9.4% of the cases respectively. The patients had a mean length of hospital stay of 3.31 ± 1.45 days. The stone clearance rate was 90.3%. 53.1% of the patients had postoperative complications with 40.6% of these being post-operative fever which resolved with antibiotics. There was treatment failure in one patient due to the inability to scope the ureter on account of ureteral stricture.


Conclusion: Ureteroscopy and laser lithotripsy are safe and effective options in the management of upper tract stones with the advantages of being performed via a natural orifice, being less painful, with reduced risk of severe bleeding, irreversible loss of renal parenchyma, as well as a short hospital stay.

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References

1. Akpakli EA, Kaestner L, Lazarus J, Norvixoxo KS. Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa : Case Study of Kidney Stones from Accra and Cape Town.Open J Urol. 2021;11:53-72.

2. Omisanjo O, Bioku M, Williams O, Akinola O, Balogun F, Ikuerowo S. A 5-Year Review of the Presentation and Management of Urolithiasis in a Nigerian Teaching Hospital. Journal of Surgery2019;7:143-147.

3. Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Adv Urol.2018;2018:3068365.4. Ansari MS, Gupta NP. Impact of socioeconomic status in etiology and management of urinary stone
disease. Urol Int.2003;70:255–261.

5. Cassell A, Jalloh M, Ndoye M,Mbodji M, Gaye O, Thiam NM et al. Surgical Management of Urolithiasis of the Upper Tract –Current Trend of Endourology in Africa. Res Rep Urol. 2020;12:225–238.

6. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M et al. 2007 Guidelinefor the management of ureteral calculi. Eur Urol2007;52:1610-1631.

7. Albdaiwi DA, Almuanni MA, Shobian MS, Moshref SM, Qarah MB, Al-jubali SS, et al. Flexible ureteroscopy and laser lithotripsy intervention for the management of stone disease. 2017;67:758–764.

8. Huang JS, Xie J, Huang XJ, Yuan Q, Jiang HT, Xiao KF.Flexible ureteroscopy and laser lithotripsy for renal stones 2 cm or greater: asingle institutional experience. Medicine2020;99:(e22704).

9. Wright AE, Rukin NJ, Somani BK. Ureteroscopy and stones: Current status and future expectations. World J Nephrol2014; 3:243–248.

10. de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M et al. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol2014;28:131-139.

11. Gautam J, Glenn SG. Ureteroscopic management of Ureteral Calculi. In: Smith AD, Badlani G, editors. Smith's textbook of endourology. 3rd edition. West Sussex (UK):Blackwell Publishing Ltd; 2012. p412-417.

12. Zheng J, Wang Y, Chen B, Wang H, Liu R, Duan B et al. Risk factors for ureteroscopic lithotripsy: a case-control study and analysis of 385 cases of holmium laser ureterolithotomy. Videosurgery Miniinv2020; 15:185–191.

13. Adanur S, Aydin HR, Ozkaya F, Ziypak T, Polat O. Holmium laser lithotripsywith semi-rigid ureteroscopy: a first-choice treatment for impacted ureteral stones in children? Med Sci Monit2014; 20:2373-2379.

14. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on interventionaltreatment for urolithiasis. Eur Urol. 2016; 69:475-482.

15. Yuk HD, Park J, Cho SY, Sung LH, Jeong CW. The effect of preoperative ureteral stenting in retrograde intrarenal surgery: a multicenter, propensity score-matched study. BMC Urol. 2020;20:147.

16. Hosking DH, McColm SE, Smith WE. "Is stenting following ureteroscopy for removal of distal ureteral calculi necessary?" J Urol. 1999;161:48-50.

17. Joshi HB, Stainthorpe RP, MacDonough RP, Keeley FX, Timoney AG. Indwelling ureteral stents: evaluation of quality of life and utility. J Urol. 2003;169:1065-1069.

18. Hatipoğlu NK, Bodakci MN, Penbegül N, Soylemez H, Sancaktutar AA, Atar M etal. Our experiences on retrograde intrarenalsurgery. Dicle Tıp Dergisi2014; 41:95-98.

19. Fuchs GJ, Fuchs AM. Flexible endoscopy of the upper urinary tract. A new minimallyinvasive method for diagnosis andtreatment.Der Urologe. Ausg.A 1990; 29:313-320.

20. Cocuzza M, Colombo JR Jr, Cocuzza AL, Mascarenhas F, Vicentini F, Mazzuchi E et al. Outcomes of flexible ureteroscopic lithotripsy with holmium laser for upperurinary tract calculi. Int. Braz J Urol. 2008;34:143-149.

21. Akpayak IC, Agbo CA, Nabasu LE. Retrograde ureteroscopy in the management of distal ureteric stones: A retrospective analysis of outcome and complications. Ann Afr Med2020;19:258-262.

22.Alabi TO, Jeje EA, Ogunjimi MA, Ojewola RW.Endoscopic management of ureteric stones: Our initial experience.Niger J Surg2019;25:26-29.

23.Johnson DB, Pearle MS. Complications of ureteroscopy. Urol Clin North Am. 2004;31:157-171.

24. Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V. Complications of 2735retrograde semirigid ureteroscopy procedures: a single centerexperience.J Endourol2006; 20:179-185.

25. Tanriverdi O, Silay MS, Kadihasanoglu M, Aydin M, Kendirci M, Miroglu M. Revisiting thepredictive factors for intra-operative complications of rigid ureteroscopy: a 15-year experience. Urol J2012;9:457-464.

26. Abdelrahim AF, Abdelmaguid A, Abuzeid H, Amin M, Mousa el-S, Abdelrahim F. Rigid ureteroscopy for ureteral stones: factors associated with intraoperativeadverse events. J Endourol 2008;22:277-280.

27. Almusafer M, Jawad Al-Tawri AM. Complicationsof ureteroscopic stone lithotripsy: A multicentre local study. Hamdan MedJ2019;12:119-125.

28. Dybowsky B, Bres-Niewada E, Rzeszutko M, Tkaczyk A, Wozniac B, Wojcik M, et al. Risk factors for infectious complications after retrograde intrarenal surgery-a systemic review and narrative synthesis. Cent European J Urol.2021; 74:437-445.

29. Yan Z, Xie G, Yuan H, Cheng Y. Modular flexible ureteroscopy and holmium laser lithotripsy for thetreatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases. Exp Ther Med. 2015;10:1467-1471.

30. Turney BW, Reynard JM, Noble JG, Keoghane SR. Trends in urological stone disease. BJU Int2012;109:1082-1087.

31. Breda A, Ogunyemi O, Leppert JT, Schulam PG. Flexible ureteroscopyand laser lithotripsy for multiple unilateral intrarenal stones. Eur. Urol.2009;55:1190–1196.