CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2018; 27(01): 074-080
DOI: 10.1016/j.uroco.2016.10.008
Original Article | Artículo Original
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Experiencia en el manejo de litiasis renal y ureteral con ureteroscopio flexible y láser holmium en un hospital público de Bogotá: estudio retrospectivo

Experience in the management of renal and ureteral calculi with holmium laser and flexible ureteroscope in a public hospital in Bogotá: A retrospective study
Diana María Cerquera Cleves
1   Residente 1.er año de urología, Universidad Nacional de Colombia–Hospital Tunal, Bogotá, Colombia
,
Andrés Felipe Puentes Bernal
2   Urólogo, Universidad Nacional de Colombia, Servicio de urología, Hospital Tunal, Bogotá, Colombia
› Author Affiliations
Further Information

Publication History

31 August 2016

18 October 2016

Publication Date:
10 January 2018 (online)

Resumen

Objetivos Discutir y evaluar la tasa libre de cálculos y las complicaciones de la ureterolitotomía endoscópica flexible con láser holmium en el manejo de cálculos ureterales y renales basada en la experiencia de un hospital público de iii nivel en Bogotá.

Material and Métodos Estudio retrospectivo en una muestra poblacional en pacientes con litiasis renal y ureteral, tratados con ureteroscopio flexible y láser holmium, evaluándose la tasa libre de cálculos, complicaciones postoperatorias y otros parámetros. El seguimiento se realizó con radiografía de abdomen y urotac al mes del postoperatorio, la tasa libre de cálculos se definió como ausencia de cálculos residuales < 4 mm en la imagen control.

Resultados Se realizaron 44 procedimientos en 43 pacientes con edad promedio de 45 años, tiempo quirúrgico promedio 91,2 min, la tasa libre de cálculos fue del 84% (37/44) en un solo evento quirúrgico; solo un paciente requirió una segunda intervención con posterior tasa libre de cálculos del 100%. La tasa libre de cálculos ureterales fue del 92% (24/26), cáliz superior 100% (2/2), cáliz medio 100%(1/1), cáliz inferior 78% (7/9) y calicial múltiple 50% (3/6). El porcentaje de complicaciones fue del 6,8%.

Conclusiones La ureterolitotomía endoscópica flexible con láser es un procedimiento efectivo y seguro en el manejo de litiasis renal y ureteral con baja incidencia de complicaciones. Observamos que en la mayoría de los pacientes con fragmentos residuales significativos estos se encontraban en cáliz inferior o se trataba de cálculos en múltiples cálices, explicándose por el difícil acceso al cáliz inferior y la carga litiásica.

Abstract

Objective To discuss and review the stone free rate and complications of using flexible ureteroscopy and holmium laser lithotripsy for treating patients with kidney and ureteral stones, based on the experience in a level III public hospital in Bogotá.

Materials and Methods A retrospective review was conducted on patients with renal and ureteral stones treated with flexible ureteroscopy and holmium laser, by analysing the stone-free rate and postoperative complications. X-rays or computed tomography was performed at 30 days post-operation to assess the effects of surgery, and the stone-free rate was defined as absence of residual stones < 4 mm on follow-up imaging.

Results A total of 44 procedures were performed on 43 patients with a mean age of 45 years. The mean operating time was 91.2 minutes, and the stone-free rate in a single surgical event was 84% (37/44). Only one patient required a second intervention, with a subsequent stone-free rate of 100%. The ureteral stone-free rate was 92% (24/26), with upper calyx 100% (2/2), middle calyx 100% (1/1), 78% lower calyx (7/9), and multiple calyceal 50% (3/6). The complication rate was 6.8%.

Conclusions Flexible ureteroscopy and holmium laser lithotripsy is an effective and safe procedure in the management of renal and ureteral stones, with a low incidence of postoperative complications. It was noted that most patients with significant residual fragments, they were in lower calyx or had multiple stones. This was explained by the difficult access to the lower calyx and stone burden.

 
  • Bibliografía

  • 1 Chen FS, Xu FB, Liu FN. , et al. Improved effectiveness and safety of flexible ureteroscopy for renal calculi (< 2 cm): A retrospective study. Can Urol Assoc J 2015; 9: E273-E277
  • 2 Giusti FG, Proietti FS, Villa FL. , et al. Current standard technique for modern flexible ureteroscopy: Tips and tricks. Eur Urol 2016; 70: 188-194
  • 3 Ghani FK, Wolf FJ, Wolf FJ. What is the stone-free rate following flexible ureteroscopy for kidney stones?. Nat Rev Urol 2015; 12: 281-288
  • 4 Lingeman FJ, Newman FD, Mertz FJ. , et al. Extracorporeal shock wave lithotripsy: The Methodist Hospital of Indiana experience. J Urol 1986; 135: 1134-1137
  • 5 Hyams FE, Munver FR, Bird FV, Uberoi FJ, Shah FO. Flexible ureterorenoscopy and holmium laser lithotripsy for the management of renal stone burdens that measure 2 to 3 cm: A multi-institutional experience. J Endourol 2010; 24: 1583-1588
  • 6 Aboumarzouk FO, Monga FM, Kata FS, Traxer FO, Somani FB. Flexible ureteroscopy and laser lithotripsy for stones > 2cm: A systematic review and meta-analysis. J Endourol 2012; 26: 1257-1263
  • 7 De FS, Autorino FR, Kim FF. , et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: A systematic review and meta-analysis. Eur Urol 2015; 67: 125-137
  • 8 Takazawa FR, Kitayama FS, Tsujii FT. Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater. Int J Urol 2012; 19: 264-267
  • 9 Xu FG, Wen FJ, Li FZ. , et al. A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy. Int J Clin Exp Med 2015; 8: 4501-4507
  • 10 Sener FN, Bas FO, Sener FE. , et al. Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology 2015; 85: 33-37
  • 11 El-Nahas FA, Ibrahim FH, Youssef FR, Sheir FK. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int 2012; 110: 898-902
  • 12 Burr FJ, Ishii FH, Simmonds FN, Somani FB. Is flexible ureterorenoscopy and laser lithotripsy the new gold standard for lower pole renal stones when compared to shock wave lithotripsy: Comparative outcomes from a University hospital over similar time period. Cent European J Urol 2015; 68: 183-186
  • 13 Kumar FA, Vasudeva FP, Nanda FB, Kumar FN, Das FM, Jha FS. A prospective randomized comparison between shock wave lithotripsy and flexible ureterorenoscopy for lower caliceal stones ≤ 2 cm: A single-center experience. J Endourol. 2015; 29: 575-579
  • 14 Pearle FM, Lingeman FJ, Leveillee FR. , et al. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 2008; 179 (I 5 Suppl): S69-S73
  • 15 Kaplan FA, Lipkin FM, Scales FC, Preminger FG. Use of ureteral access sheaths in ureteroscopy. Nat Rev Urol 2016; 13: 135-140
  • 16 Auge FB, Pietrow FP, Lallas FC, Raj FG, Santa-Cruz FR, Preminger FG. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004; 18: 33-36
  • 17 Stern FJ, Yiee FJ, Park FS. Safety and efficacy of ureteral access sheaths. J Endourol 2007; 21: 119-123
  • 18 Berquet FG, Prunel FP, Verhoest FG, Mathieu FR, Bensalah FK. The use of a ureteral access sheath does not improve stone-free rate after ureteroscopy for upper urinary tract stones. World J Urol 2014; 32: 229-232
  • 19 Redondo FC, Ramón de Fata FF, Gimbernat FH, Meilán FE, Andrés FG, Angulo FJ. Retrograde intrarenal surgery with holmium-YAG laser lithotripsy in the primary treatment of renal lithiasis. Actas Urol Esp 2015; 39: 320-326
  • 20 Gallo FJ, Uribe FC. Ureterorrenoscopia flexible con Ho:YAG láser en el manejo de la litiasis del tracto urinario superior. Descripción de los primeros 80 casos. Urol Colom 2009; 3: 83-92
  • 21 Shek Padilla FA, Otero Andrade FF, Agressot Guerra FW. , et al. Nefrolitotomía retrógrada flexible láser de holmium: primeros 100 casos. Urol Colomb. 2014; 23: 103-108
  • 22 Dindo FD, Demartines FN, Clavien FP. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
  • 23 Hyams FE, Monga FM, Pearle FM. , et al. A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. J Urol 2015; 193: 165-169
  • 24 Donaldson FJ, Lardas FM, Scrimgeour FD. , et al. Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy for lower-pole renal stones. Eur Urol 2015; 67: 612-616
  • 25 Ito FH, Sakamaki FK, Kawahara FT. , et al. Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones. BJU Int 2015; 115: 446-451
  • 26 Ito FH, Kawahara FT, Terao FH. , et al. Evaluation of preoperative measurement of stone surface area as a predictor of stone-free status after combined ureteroscopy with holmium laser lithotripsy: A single-center experience. J Endourol 2013; 27: 715-721
  • 27 Inoue FT, Murota FT, Okada FS. , et al. Influence of pelvicaliceal anatomy on stone clearance after flexible ureteroscopy and holmium laser lithotripsy for large renal stones. J Endourol 2015; 29: 998-1005
  • 28 Akman FT, Binbay FM, Ozgor FF. , et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2–4 cm stones: A matched-pair analysis. BJU Int 2012; 109: 1384-1389
  • 29 Neira FI, Celis FE, Zapata FM. Seguridad de la ureteroscopia flexible sin camisa de acceso ureteral. Urol Colomb 2014; 23: 171-176
  • 30 Eisner FB, Dretler FS. Use of the Stone Cone for prevention of calculus retropulsion during holmium: YAG laser lithotripsy: Case series and review of the literature. 2009; 82: 356-366