Category: Stones: Ureteroscopy
Introduction & Objective : To present a new approach to treat kidney stone. Using a combination of extracorporeal shockwave lithotripsy and intracorporeal laser lithotripsy through flexible ureteroscopy.
Methods : A pilot study was conducted in Siriraj Hospital between January 2017 and December 2017. 149 consecutive cases of kidney stone underwent surgery performed by a single surgeon were enrolled in the study. Three modalities to treat large kidney stone included percutaneous nephrolithotripsy (PCNL), retrograde intrarenal surgery (RIRS), and hybrid lithotripsy (extracorporeal shockwave lithotripsy and RIRS) were compared. Stone free rate (SFR) and complication were determined as the primary results. Stone size and location as well as degree of hydronephrosis were evaluated as the factors associate with stone free rate for each modality.
Results : Of these 149 procedures, there were 29 PCNL, 100 RIRS, and 20 hybrid lithotripsy. Mean stone diameter for PCNL, RIRS, and hybrid lithotripsy were 4.5 cm, 2 cm, and 3.5 cm respectively. Overall stone free rate (SFR) for PCNL, RIRS, and hybrid lithotripsy were 52%, 72% and 45% respectively. For lower pole kidney stone size 2-3 cm, SFR for PCNL, RIRS, and hybrid lithotripsy were 100%, 40% and 75% respectively. Post operative fever was the most common found in three modalities. Factors enhanced SFR were pre-stented status and patients who had uric acid or struvite stone.
Conclusions : Hybrid lithotripsy is a new approach to treat kidney stone. Favorable outcomes were achieved with acceptable SFR and particularly its less invasiveness. According to the study we recommended this approach for large lower pole kidney stone.