Modular Flexible Ureteroscope Combined with Holmium Laser Lithotripsy in the Treatment of Renal Calculi: Report of 72 Cases

［Abstract］Objective　To explore the clinical value of modular flexible ureteroscope combined with holmium laser lithotripsy in the treatment of renal calculi. Methods　From November 2013 to June 2015，72 patients with renal calculi were treated by modular flexible ureteroscope（Polydiagnost，German）combined with holmium laser lithotripsy. The diameter of stones was 10-45 mm，16 mm on average. Twenty cases were indwelling double J tube for 3-4 weeks before operation. 200 μm holmium laser fiber was used and laser power was set to 1.5J/10-20Hz（5 to 30 W）. KUB examination was performed 1 month after operation．Results　Seventy-two cases were treated. F12 ureter sheath was successfully inserted into ureter in 56 cases， and failed in 16 cases. In 6 cases，modular flexible ureteroscope was put into renal pelvis and calices with the help of guidewire，and stones were successfully treated. MPCNL was selected to treat calculi in 6 cases，and modular flexible ureteroscope lithotripsy was successfully applid after double J tubes were placed for 4 weeks in 4 cases. Lower renal calyceal calculi were not found in 6 cases cases，ESWL was selected to treat these cases after double J tube indwelling. The stone found rate was 90.9%（60/66）. KUB was examined 1 month after operation. Residul stones were found in 5 cases. Total free rate was 91.7%（55/60）through single operation. Calculus lines up clean the zone leading 95% credibilities is 84.84%-98.56%. The time of lithotripsy was 20-150 min，and the average time was 50 min. During operation， perfusion fluid extravasation and peritoneal effusion were found in 1 case. No severe complications such as heavy bleeding， ureteral avulsion or perforation， urinary tract infection were found in all cases. The average hospitalization was 3 days after modular flexible ureteroscope．Conclusions　Modular flexible ureteroscope is easy to operate， and the usage cost is lower. The technology， modular flexible ureteroscope combined with holmium laser lithotripsy for treatment of renal calculi， has the advantages of minimal invasion，high safety and effectiveness， less complications. So this technology is worthy of clinical popularization and application.