[The value of retrograde ureterorenoscopy in the treatment of bulky kidney calculi].

OBJECTIVE

To assess the value of retrograde endoscopic lithotripsy for very large pyelocaliceal stones.

MATERIAL AND METHODS

Eighteen patients between the ages of 28 and 80 years (mean : 52) and presenting a staghorn renal calculus (n = 7) or with a maximal diameter greater than or equal to 20 mm (n = 11) were initially managed by rigid or flexible retrograde ureterorenoscopy, with ballistic (Lithoclast) or electrohydraulic (Riwolith) stone fragmentation. In 16 cases (89%), an additional extracorporeal shock-wave lithotripsy (ESWL) session was performed immediately after the endoscopic procedure. Early complications consisted of 3 cases of bacteraemic discharge rapîdly responding to medical treatment and 1 death from septic shock on the 8th postoperative day. Twelve patients (67%) were subsequently treated by ureteroscopy (n = 4) or ESWL (n = 11).

RESULTS

17 patients were evaluated after this therapeutic procedure, with a follow-up of 3 to 6 months (mean : 4). Stone elimination was complete for 8 patients (47%), 3 of whom initially presented a staghorn calculus. A residual stone was observed in 9 cases (53%), with a maximal diameter < 5 mm in 7 cases (41%). One patient (5%) underwent secondary percutaneous nephrolithotomy.

CONCLUSION

Technological progress has clearly facilitated the ureteroscopic approach to very large pyelocaliceal stones, but fragmentation and stone elimination remain problematical. This unconventional approach constitutes a potential field of technical progress, but does not represent a really efficient alternative to PCNL at the present time.