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| Retrograde intrarenal surgery: An expanding role in treatment of urolithiasis |
María Rodríguez-Monsalve Herrero,Steeve Doizi,Etienne Xavier Keller,Vincent De Coninck,Olivier Traxer( )
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| Department of Urology, Tenon Hospital, Assistance-Publique H?pitaux de Paris, Paris, France |
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Abstract During the past 3 decades, the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy. The development of this instrument as well as ancillary equipment such as baskets, graspers, and others, and improvements in lithotripsy with Holmium: YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors. The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.
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Received: 13 April 2018
Published: 19 November 2018
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| Fund:Etienne Xavier Keller is supported by a Travel Grant from the University Hospital Zurich and a grant from the Kurt and Senta Herrmann Foundation;Vincent De Coninck is supported by a EUSP scholarship from the EAU and a grant from the Belgische Vereniging voor Urologie(BVU) |
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Corresponding Authors:
Traxer Olivier
E-mail: olivier.traxer@aphp.fr
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| AUA/ES recommendation | Grade of recommendation | EAU recommendation | Level of evidence | | Surgical management of distal uretal stones | >10 mm | Strong recommendation | >10 mm | - | | 1. URS | 1. URS | | 2. SWL | 2. SWL | | <10 mm | Strong recommendation | <10 mm URS or SWL | - | | 1. URS | | 2. SWL | | URS for cystine or uric acid ureteral stones | Expert opinion | | | | Surgical management of proximal uretal stones | >10 mm 1. URS | Strong recommendation | >10 mm | - | | 1. URS | | 2. SWL | | <10 mm 1. URS | Strong recommendation | <10 mm | - | | 1. URS | | 2. SWL | | | For severe obesity, URS is a more promising option than SWL. | 2b | | Use PCNL for ureteral stones as an alternative when SWL is not indicated or has failed or when URS is impossible. | - |
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| AUA/ES Recommendation | Grade of recommendation | EAU recommendation | Level of evidence | | Surgical management of renal stones, lower pole excluded | <10 mm
SWL or fURS
10-20 mm
SWL or fURS
>20 mm
1. PCNL
2. fURS
No SWL as first-line treatment | Strong recommendation | <10 mm
1. SWL or fURS | - | | 2. PCNL | | | Strong recommendation | 10-20 mm
SWL or endourology (fURS or PCNL) | - | | Strong recommendation | >20 mm
1. PCNL | - | | Strong recommendation | 2. SWL or fURS | | | Strong recommendation | | Surgical management of renal stones, lower pole | <10 mm
SWL or fURS
10-20 mm
fURS or PCNL
No SWL as first-line treatment
>20 mm
1. PCNL
2. fURS
No SWL as first-line treatment | Strong recommendation | <10 mm
1. SWL or fURS | - | | 2. PCNL | | | Moderate recommendation | 10-20 mm
SWL or fURS or PCNL | - | | Strong recommendation | | | | Strong recommendation | >20 mm
1. PCNL | - | Strong recommendation
Strong recommendation | 2. fURS or SWL
Use fURS if PCNL or SWL are not an option (even for stones >2 cm) | - |
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