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Traxer O et al, 2013: Extracorporeal lithotripsy endoscopically controlled by ureterorenoscopy (LECURS): a new concept for the treatment of kidney stones-first clinical experience using digital ureterorenoscopes

Traxer O, Letendre J
Urology Department, Tenon Hospital, Pierre and Marie Curie University, 4 rue de la Chine, Paris Cedex 20, 75970, France


Abstract

PURPOSE: To evaluate the feasibility and usefulness of extracorporeal lithotripsy endoscopically controlled by simultaneous flexible ureterorenoscopy (LECURS) and combined with Holmium laser lithotripsy for kidney stones surgery.

METHODS: Retrograde flexible ureteroscopy allowed stone visualization and intrarenal relocation when possible. Extracorporeal shock wave lithotripsy (ESWL) was performed under direct vision allowing constant focal zone adjustment for optimal stone fragmentation. Holmium laser lithotripsy was used simultaneously when necessary. Post-operative assessment included ultrasound at day one and abdominal CT scan 3 weeks later to evaluate for residual fragments.

RESULTS: Six patients with kidney stones were recruited including 3 with relative contraindication to ESWL. One patient had a stone beyond an infundibular stenosis and 2 had multiple stones in a horseshoe kidney with an uretero-pelvic junction (UPJ) stricture. A 100 % stone fragmentation rate was obtained. Post-operative ultrasound was normal in 5 patients and showed slight peri-renal infiltration in the other. One patient developed an obstructive pyelonephritis requiring antibiotics and changing a double J to a ureteral catheter. No other complications were noted. Three patients (50 %) were stone free after LECURS. Three patients underwent a second-look procedure for small (<3 mm) retained residual fragments. No damage was seen with the digital ureteroscopes, laser fibers or stone baskets.

CONCLUSIONS: This initial experience with LECURS has shown to be feasible and safe. This opens the opportunity for further evaluation of this approach in order to improve outcomes of both approaches.

World J Urol. 2013 Aug 3. [Epub ahead of print]
PMID:23913096 [PubMed - as supplied by publisher]

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Comments 1

Peter Alken on Tuesday, 15 October 2013 14:05

I remember the surprising video on combined URS+SWL that G. Fuchs (Reference 4: Patel A, Fuchs GJ (1997) Expanding the horizons of SWL through adjunctive use of retrograde intrarenal surgery: new techniques and indications. J Endourol 11(1):33–36) showed some 25 years ago. Since then this combined procedure has not found a wide spread application. It may be more efficient with the digital scopes used in this feasibility study and it may be an approach to be aware of in special cases.

In this small series 6 patients had 18 ureterorenoscopies and 6 SWLs. That is 24 procedures not counting one preoperative double J Stent, one ureteral catheter for intermittent temporary drainage of the collecting system and 6 double J stent removals which would add to a total of 32 interventions. 6 well performed PNLs could probably have done the same job.

Peter Alken

I remember the surprising video on combined URS+SWL that G. Fuchs (Reference 4: Patel A, Fuchs GJ (1997) Expanding the horizons of SWL through adjunctive use of retrograde intrarenal surgery: new techniques and indications. J Endourol 11(1):33–36) showed some 25 years ago. Since then this combined procedure has not found a wide spread application. It may be more efficient with the digital scopes used in this feasibility study and it may be an approach to be aware of in special cases. In this small series 6 patients had 18 ureterorenoscopies and 6 SWLs. That is 24 procedures not counting one preoperative double J Stent, one ureteral catheter for intermittent temporary drainage of the collecting system and 6 double J stent removals which would add to a total of 32 interventions. 6 well performed PNLs could probably have done the same job. Peter Alken
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