Introduction & Objectives
This is the initial experience from our country to evaluate the outcomes of stone treatment using ureterorenoscopy (URS) among patients (pts) with anomalies of kidneys and ureters (AKU).
Material & Methods
We conducted a retrospective mono center study including all URS for urinary lithiasis performed for pts with AKU in our department between January 2013 and April 2017. Overall, 7 pts with AKU underwent URS treatment of the ureter and kidney stones. There were complete doubling of upper urinary tract in 4 pts, in 1 case there was an incomplete doubling (but both ureter coupled in intravesical part). One patient had horseshoe kidney and in another case the combined anomaly was observed (hypoplasia of the right kidney with stenosis of ureterovesical joint of another ureter with caliceal stones. For visualization we used 9,5Fr ureterorenoscope and flexible endoscope Flex-XC. The lithotripter system used in all cases was Ho:YAG Laser.
URS was performed as a completely standardized operation by the same surgeon. Medium cumulative stone size was 8,5 mm (8-16mm); in 4 pts, multiple calculi were extracted. There was no difference neither in time of operation no in complications rate between the studied pts and others. There were only minor complications. All pts were discharged from the department in 24 hours. The stone free rate after 3 months of URS was 100%. All pts underwent single-stage procedures. Here we describe a clinical case: 50 years old woman has come to the department of urology with pain which at the end of urination. Two months previously for patient was performed right sided ureterorenoscopy with JJ-stent inserting for the stones (15 mm, 4 mm) in the orifice of the right ureter. However, after stent removal the complaints of the patient have renewed. In our clinic for the patient was performed contrasted CT which has revealed two stones in the orifice of the right ureter and incomplete duplication of a right kidney when both ureters connected in the bladder wall (picture a,b,c). During cystoscopy right and left orifices were normally located. Under endoscopic and X-ray control we performed right sided ureteroscopy but did not find any stone. We made section of a back wall of the orifice by the holmium laser and find the stones in the orifice of an additional ureter which was confirmed under X-ray control (picture d). The stones were crushed by laser lithotripsy and this ureter was stented for 3 weeks.
URS is a safe and effective procedure in pts with AKU. This procedure is associated with high range of stone free status in treatment of kidney stones in this group pts. URS is very feasible and comfortable procedure to perform for kidney stones under spinal anesthesia as general anesthesia. URS is free from some danger complications of percutaneous and extracorporeal shock wave lithotripsy which can be very harmful in pts with AKU.