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Review
. 2015 Feb 6;4(1):111-7.
doi: 10.5527/wjn.v4.i1.111.

Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach

Ryoji Takazawa  1 , Sachi Kitayama  1 , Toshihiko Tsujii  1
Affiliations
Review

Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach

Ryoji Takazawa et al. World J Nephrol. .

Abstract

Flexible ureteroscopy (fURS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy (PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged fURS is a practical treatment for such large kidney stones because fURS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged fURS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with fURS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.

Keywords: Kidney calculi; Laser; Lithotripsy; Nephrostomy; Percutaneous; Ureteroscopy.

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Figures

Figure 1
Figure 1
Our proposed treatment algorithm for kidney stones. fURS: Flexible ureteroscopy; PNL: Percutaneous nephrolithotomy; SWL: Shock wave lithotripsy.
See this image and copyright information in PMC

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