Retrograde holmium:YAG laser disintegration of stones in pelvic ectopic kidneys: would it minimize the risk of surgery?

摘要

PURPOSE: To study the safety and efficacy of the holmium:YAG laser for disintegration of stones in pelvic ectopic kidneys. PATIENTS AND METHODS: Between October 2005 and October 2006 four consecutive patients with large obstructing calculi (>3 cm in diameter) in the pelves of pelvic ectopic kidneys were prepared to be treated using retrograde ureterorenoscopy and holmium:YAG laser lithotripsy. All the patients were investigated with x-rays of the kidney, ureters, and bladder (KUB) and intravenous urography (IVU). Holmium:YAG laser lithotripsy was performed in a retrograde manner using energy ranging from 1 to 1.5 J/pulse with a frequency ranging from 15 to 20 Hz. RESULTS: Four patients were included in the study. The average age of the patients was 44 years (range 35-56 years). The average operative time for the laser lithotripsy procedure was 120 minutes (range 100-180 minutes). Three of the patients (75%) were rendered stone-free at 3 months. None of the patients developed back-pressure changes, gross hematuria, or abdominal pain during the follow-up period. One of the patients could not be treated endoscopically and required open surgery. Hospital stay ranged between 2 and 3 days. CONCLUSION: Retrograde ureteroscopy and holmium:YAG laser lithotripsy is efficacious for managing patients with stones in pelvic kidneys. The procedure is safe and effective and avoids the complications of open surgery.