Transurethral Digital Endoscopic Renal Surgery: A New Minimally Invasive Pathway For The Treatment Of Lithiasic And Renal Reconstructive Pathology

Objective/Introduction: Technological improvements in urologic instrumentation have allowed us to treat endoscopically through natural orifices without skin incisions. We present our initial experience with the technique of retrograde intrarenal surgery (RIRS) utilizing new video flexible ureterorenoscope and Holmium laser.Patients and Methods: We reviewed medical records of 15 patients (17 renal units) who underwent RIRS with holmium laser from December 2011 to April 2012. The median follow-up was 2 months. In 16 of 17 cases RIRS was done to remove renal stones, and one case of recurrence uretero-pelvic junction obstruction. The main indication was pain (88%), urinary infection (23%) and renal failure (23%). Mean renal stone size was 14 mm, the most common location were inferior calyx and pelvic. The majority of cases renal stones were isolated (88%).Two different types of ureteroscopes were used, Olympus digital video ureterorenoscope and Wolf semirigid ureteroscope. Holmium laser fibers (270 and 400 microns) were used according to stone size and location.Results: The mean procedure time was 80 minuts. Overall success rate (stone free rate and clinical insignificant residual fragments) was 94% (16/17 patients); the stone free rate was 65% (11/17) and clinical insignificant residual fragments were observed in 5 patients (29%). The mean hospital stay was 1.5 days (95% C. I; 12); Regarding complications, 3 patients had hematuria without blood trasfussions, and one patient had urosepsis without any adverse clinical consequence. An Auxiliary procedure needed to treat residual stones were not observed in any patient. One patiens presented at the emergency room with pain secondary to the double JJ ureteral stent.Conclusions: RIRS is an attractive safe and effective technique with low morbidity and high success rate in urolithiasis inferior to 1.5 cm of diameter. Therefore, it could be proposed as a real alternative therapy, specially in groups of high risk of ESWL failure like pregnants, obesity, bleeding disorders, bilateral and multiple renal stones.