Staged flexible ureteroscopy with holmium laser lithotripsy for the treatment of diameter ≥4 cm complex nephrolithiasis:a retrospective study of 389 cases
Objective:To investigate the safety and efficacy of staged flexible ureteroscopy with holmium laser lithotripsy(FURL)for the treatment of complex nephrolithiasis.Methods:We retrospectively analyzed 389 patients with unilateral large renal stones(≥4 cm in diameter)who had undergone staged FURL from January 2013 to December 2023.We analyzed the number and duration of proce-dures performed,the length of hospital stay,the cost of hospitalization,the stone clearance rate,and the incidence of complications(fever,urosepsis,severe hemorrhage,steinstrasse,etc.).Results:Each patient underwent at least two procedures,and 22 patients underwent three procedures.The mean duration of stage-1 procedures was(84.60±21.34)minutes.The mean duration of stage-2 procedures was(89.70±19.17)minutes,with a stone clearance rate of 94.60％.The mean duration of stage-3 procedures was(72.50±17.30)minutes,with a stone clearance rate of 90.90％.There were 21 events of fever(7 cases of urosepsis),76 events of steinstrasse,and 30 events of gross hematuria.Conclusion:Staged FURL is safe and effective for treating large stones in the kidney,but its high cost is a concern to the patients.
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