PMID- 24083332
OWN - NLM
STAT- MEDLINE
DCOM- 20140509
LR  - 20220309
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 28
IP  - 2
DP  - 2014 Feb
TI  - Flexible ureterorenoscopy for lower pole stones: influence of the collecting 
      system's anatomy.
PG  - 146-51
LID - 10.1089/end.2013.0401 [doi]
AB  - BACKGROUND: The impact of renal anatomy on the success rate of flexible 
      ureterorenoscopy (fURS) for lower pole stones is less clear than it is on shock 
      wave lithotripsy, for which it is a recognized influence factor. We analyzed 
      safety and efficiency of fURS using modern endoscopes for lower pole stones 
      dependent on the collecting system's configuration. PATIENTS AND METHODS: We 
      retrospectively evaluated a consecutive sample of 111 fURS for lower pole stones 
      at our tertiary care center between January 2010 and September 2012 from our 
      prospectively kept database. All procedures were performed with modern flexible 
      ureterorenoscopes, nitinol baskets, holmium laser lithotripsy, and ureteral 
      access sheaths whenever needed. The infundibular length (IL) and width (IW) and 
      infundibulopelvic angle (IPA) were measured and the data were stratified for 
      stone-free status and complications classified by the Clavien-Dindo scale. 
      Univariate and multifactorial statistical analyses were performed. Correlation of 
      operation time (OR-time) with anatomical parameters was conducted. RESULTS: 
      Ninety-eight (88.3%) of the 111 patients were stone free after a single fURS. On 
      multifactorial analysis, the stone size and IL had significant influence on the 
      stone-free rate (SFR) (p<0.01), whereas IW did not. An acute IPA (<30 degrees ) also had 
      significant influence (p=0.01). The incidence of complications and OR-time were 
      not influenced by the pelvicaliceal anatomy. CONCLUSIONS: fURS is a safe and 
      efficient treatment option for lower pole kidney stones. A long infundibulum and 
      a very acute IPA (<30 degrees ) negatively affect the SFR. However, with second look 
      procedures, a complete stone clearance is achievable even in case of unfavorable 
      anatomic conditions. A narrow infundibulum has no negative effect while using 
      modern endoscopes. The complication rate is not affected by the collecting 
      system's anatomy.
FAU - Jessen, Jan Peter
AU  - Jessen JP
AD  - Department of Urology, Sindelfingen-Boeblingen Medical Center, University of 
      Tubingen , Sindelfingen, Germany .
FAU - Honeck, Patrick
AU  - Honeck P
FAU - Knoll, Thomas
AU  - Knoll T
FAU - Wendt-Nordahl, Gunnar
AU  - Wendt-Nordahl G
LA  - eng
PT  - Journal Article
DEP - 20131119
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kidney Calculi/*diagnosis/surgery
MH  - Kidney Tubules, Collecting/anatomy & histology/*pathology/surgery
MH  - Lasers, Solid-State
MH  - Length of Stay
MH  - Lithotripsy, Laser
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Retrospective Studies
MH  - Tertiary Care Centers
MH  - *Ureteroscopy
EDAT- 2013/10/03 06:00
MHDA- 2014/05/10 06:00
CRDT- 2013/10/03 06:00
PHST- 2013/10/03 06:00 [entrez]
PHST- 2013/10/03 06:00 [pubmed]
PHST- 2014/05/10 06:00 [medline]
AID - 10.1089/end.2013.0401 [doi]
PST - ppublish
SO  - J Endourol. 2014 Feb;28(2):146-51. doi: 10.1089/end.2013.0401. Epub 2013 Nov 19.