Flexible ureterorenoscopy for the treatment of refractory upper urinary tract stones

Objective To report our experience of using flexible ureterorenoscopy for u pper urinary tract stones. Patients and methods Thirty-seven patients (13 females, 24 males, mean age 48 years, range 10-76) with upper urinary tract stones not responding to ot her treatments had their residual symptomatic stones treated through a 9.3 F flexible ureterorenoscope. Electrohydraulic lithotripsy (EHL) was used to fragment the stones and a basket or a grasper used to retrieve the fragmen ts. Results Twenty-three patients were completely freed of stone and a further five had asymptomatic residual fragments of < 5 mm. Of 15 patients with ure teric stones, 14 were rendered stone-free at the end of the procedure and 1 4 of the 22 patients with kidney stones were treated successfully; 80% of t he lower calyceal stones were treated successfully and a firm decision was possible on the further management of the remaining stones. There were no m ajor complications. Conclusion Flexible ureterorenoscopy should be considered in patients with symptomatic upper ureteric or renal stones refractory to other treatments, but the instrumentation is expensive and delicate, and its use should be re served for such cases.