Flexible ureteroscopy combined with holmium laser lithotripsy for calculi of solitary kidney: report of 12 cases

Objective To investigate the safety and efficacy of flexible ureteroscopy combined with holmium laser in treatment of calculi of solitary kidney. Methods A retrospective analysis was carried out on the clinical data of 12 patients with calculi of solitary kidney, who underwent flexible ureteroscopy combined with holmium laser from February 2014 to April 2015. Among them, 7 cases were male, 5 cases were female, with average age of 43 years (range, 39–67). Three patients were new–onset, 9 patients were with residual stone after treatment (2 cases after open surgery of stone removal, 5 cases after percutaneous nephrolithotripsy, while 2 cases after ESWL treatment). The average stone diameter was 1.8 cm (0.6–3.5 cm). Four cases were single stone, 8 cases were multiple stones. Results The ureteroscope and holmium laser lithotripsy was successfully completed in all the 12 patients. The average surgery time was 118 min (54–182 min). Average hospital stays were 4.5 days. Ureteral stent was remained for 2–4 weeks. One patient got chills and fever after operation, and was cured after anti–infection treatment. One patient had gross hematuria after operation, which disappeared 2 days later. No serious complications were seen in other patients. Among 7 cases of patients with normal serum creatinine before operation, no obvious changes of serum creatinine were seen at postoperative 1–month follow–up; among 5 cases of patients with preoperative renal insufficiency, renal function of 2 cases were restored to normal, and the rest 3 cases had different degrees of decline of serum creatinine. KUB or CT scan confirmed that no significant residual stones were found in 10 cases. One–stage stone clearance rate was 83% (10/12). One patient had residual stones in the subrenal calyx. The residual stone was 4 mm in diameter. Another patient with staghorn calculi received 3 times of lithotripsy and no residual calculi were left. Conclusions Flexible ureteroscopy combined with holmium laser is safe and effective in treatment of calculi of solitary kidney. It has the advantages of small trauma, less bleeding, fewer complications and quicker recovery. Key words: Flexible ureteroscopy; Holmium laser; Solitary kidney; Kidney calculi