Abstract

Objective: We evaluated retrograde intrarenal surgery (RIRS) using flexible ureterorenoscopy (f-URS) for the treatment of lower pole calyx stones.

Materials and methods: Twenty-eight patients (20 males, 8 females; mean age 49 years; range 26 to 80 years) underwent RIRS using f-URS for lower pole calyx stones in 31 renal units. Nine patients had isolated but symptomatic lower calyx stones, of which two patients had bilateral involvement, and extracorporeal shock wave lithotripsy was unsuccessful in six patients. In 16 patients (1 patient had bilateral involvement) RIRS was performed in the same session following treatment of ipsilateral ureteral stones. Three patients had multiple calyx stones. In appropriate cases, the stones were taken into a Nitinol basket and displaced to the upper calyx. The stones were fragmented using a 0.2-mm holmium:YAG laser probe and fragments larger than 2 mm were removed. A JJ ureteral catheter was placed when necessary. Radiologic controls could be made in 22 patients (78.6%) in the postoperative 4 to 6 weeks.

Results: The mean stone size was 8.5±2.9 mm (range 3 to 20 mm) and the mean operation time was 118±35 min (range 60 to 165 min). In three cases in which the pelvicalyceal system could not be reached via f-URS due to proximal ureteral stricture, percutaneous nephrolithotripsy was performed in one case, and a JJ stent was placed in two cases and lithotripsy with f-URS was performed four weeks later. No perioperative or postoperative major complications were encountered. The mean hospital stay was 1.1 days (range 0 to 2 days). In radiologic controls, 10 (90.9%) of 11 patients were found stone-free by ultrasonography, and kidney, ureter, and bladder X-ray, compared to seven (63.9%) of 11 patients by thin-section computed tomography.

Conclusion: Flexible ureteroscopes are effectively and safely used in the treatment of lower calyx stones. During endoscopic treatment of ureteral stones, ipsilateral lower calyx stones can also be treated successfully by RIRS.