Retrograde Ureteroscopy for Renal Stones Larger Than 2.5 cm

Introduction and Objectives: Because of the advances in endoscopic technology, retrograde flexible ureteroscopy (URS) is being applied to larger renal stone burdens. For stones greater than 2.5 cm, percutaneous nephrolithotomy has long been considered the standard of care. We have encountered a growing population of patients who desire a less invasive, less disruptive approach to large renal stones. We present our experience with retrograde ureteroscopic management of renal stones larger than 2.5 cm. Methods: Twenty-two patients between October 2004 and June 2008 underwent retrograde flexible URS with holmium laser lithotripsy. Each patient underwent retrograde URS using the Storz Flex-X and a ureteral access sheath. Patients were evaluated for number of procedures, stone clearance rates, and hospital admissions. Postoperative kidney, ureter, and bladder radiograph was used to determine stone-free rates. Results: Mean stone size was 3.0 cm. The average number of procedures was 1.82 with 5 patients requiring one, 14 requiring two, and 1 requiring three procedures. There were two failures who went on to have percutaneous nephrolithotomy, both of whom had significant lower pole stone burden. Overall stone-free rate was 90.9%. There were three overnight admissions for stent pain, and one 3-day admission for bacteremia in a patient who was noncompliant with preoperative antibiotics. Conclusions: Planned staged URS is a viable option for the treatment of renal stones larger than 2.5 cm with excellent stone-free results. Significant lower pole stone burden is a limiting factor.