Ureteroscopic Management of Lower Pole Renal Calculi
Delvecchio F, Kourambas J, Munver R, Preminger G

INTRODUCTION: Current ureteroscopic intracorporeal lithotripsy devices and basket technology now allow for the treatment of stones throughout the intra-renal collecting system. Occasionally, ureteroscopic management of lower pole calculi is warranted. We retrospectively reviewed our experience where lower pole renal calculi were ureteroscopically managed by stone fragmentation and/or basket retrieval. Twenty-six patients underwent ureteroscopic treatment of lower pole renal calculi between April, 1998 and May, 1999. Lower pole stones less than 1.5 cm were primarily treated by ureteroscopic means in patients: who were obese; with a solitary kidney; with cystine or CaOx monohydrate stones; with complicated intra-renal anatomy; or as a salvage procedure after failed SWL. Lower pole calculi were approached with a7.5F flexible ureteroscope and the 200 holmium laser fiber was the first choice for stone fragmentation. For those patients where the laser fiber reduced ureteroscopic deflection, precluding re-entry into the lower pole, a nitinol basket or nitinol graspers were used to displace lower pole calculi into the renal pelvis, for easier fragmentation.

RESULTS: In 18 patients, in situ holmium laser fragmentation was successfully performed. In the remaining 7, a nitinol device was used for stone displacement. The nitinol device could be passed into the lower pole, through the fully deflected ureteroscope, without any loss of deflection. Irrigation was significantly reduced by the 3.2 F basket, but improved with the 2.4 F nitinol graspers. This factor did not impede stone retrieval in any of the patients. 78% of patients were stone free by IVP/tomos performed @ 3 months.

CONCLUSIONS: Ureteroscopic management of lower pole calculi is a reasonable Alternative to SWL or PNL in patients with low volume stone disease. If the stone can not be fragmented in situ, nitinol basket or gasper retrieval, through a fully deflected ureteroscope into a less dependent position, facilitates stone fragmentation.

Journal of Endourology, Vol. 13 Supplement 1, A122 Sep 1999

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