Endourology and StonesHigh- vs Low-power Holmium Laser Lithotripsy: A Prospective, Randomized Study in Patients Undergoing Multitract Minipercutaneous Nephrolithotomy
Section snippets
Patients
From January 2008 to September 2010, 273 consecutive patients with large staghorn kidney stones (diameter ≥4 cm, based on kidney-ureter-bladder [KUB] films) in our hospital, irrespective of the number of stones and amount of hydronephrosis, were randomly enrolled to undertake multitract MPCNLs with a pulsed Ho:YAG laser (VersaPulse 100 PowerSuite, Coherent Medical Group, Santa Clara, CA). Exclusion criteria were general contraindications of surgery, uncorrectable coagulation disorders,
Results
Two-hundred ninety-one renal units in 273 patients were successfully treated with single-session PCNLs. The average patient age was 49.2 years (range 22-73). The stone size was defined as the maximal diameter measured on the preoperative X-ray film, and the average stone size was 5.54 ± 0.7 cm. The 2 groups had comparable demographic data and baseline characteristics (Table 1).
Of the 291 treated renal units, 762 tracts were established and the number of tracts required per renal unit was 2-4.
Comment
The treatment of large, complete staghorn calculi usually requires a sandwich combination of PCNL and shockwave lithotripsy or sometimes open surgery.11 Complete removal of the stone is an important goal to prevent further stone growth and any associated infection, and to preserve renal function.12 The goal to a complete removal of the renal staghorn calculi has encouraged multiple tracts carried out in a single session of PCNL.1, 2 Despite the fact that standard PCNL is a well-recognized,
Conclusions
A combination of multitract MPCNL and high-power Ho:YAG laser lithotripsy can greatly decrease the operative time without increasing the intraoperative complications or delaying postoperative renal function recovery when compared with low-power Ho:YAG laser lithotripsy.
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Cited by (0)
Shushang Chen and Lingfeng Zhu contributed equally to this work.