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Objectives: Urosepsis currently accounts for half of all post flexible ureterorenoscopy (F-URS) complications, with an incidence of up to 4.3%. It represents a quarter of all septic episodes in adults and 2% of hospital spendings. The primary objective of this study was to define the predictive clinical parameters that increase the risk of urosepsis after F-URS., Subjects/patients (or Materials) and Methods: This prospective multicentric study evaluated patients who underwent F-URS for calculus between June 2016 and June 2018 in eleven French centers. Clinical, bacteriological, morpho-constitutional stone data, intraoperative information and complications were compared. Risk factors for postoperative urosepsis were identified and analyzed., Results: We included 486 F-URS in 432 patients. The ureter was prepared using a double J stent in 51% of cases, a digital endoscope was used in 56% of patients with a median operative time of 120 min IQR (90-125) and using a sheath in 90% of cases. Postoperative urosepsis was observed in 18 patients (4%) with a median time to onset of 2 days IQR (1-5). The presence of coronary insufficiency: 3 (17%) vs 14 (3%) p = 0.005, a larger stone diameter: 11 cm [9-17] vs 10 cm [8-13] p = 0.02, a positive preoperative urine culture even when treated: 3 (17%) vs 56 (12%) p = 0.04, as well as the final composition of the type IV calculus (carbapatite or struvite) 5 (28%) vs 20 (4%) p < 0.001, were significantly associated with the occurrence of urosepsis. In multivariate analysis, only the presence of a type IV stone (OR = 14.0; p = 0.025) remained significant., Conclusion: Ureteroscopic treatment of a type IV stone (carbapatite or struvite) in a patient should raise concerns about the risk of post-operative urosepsis. When recognized intraoperatively, they should lead to a pyelic urinary sample and prolonged clinical surveillance., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To evaluate the feasibility, efficiency, and predictive factors of therapeutic success of Vibration, Diuresis and Inversion (VDI) therapy for the removal of upper urinary tract stones., Methods: It is a retrospective, single-center study at the CHU - La Conception, Marseille, France including all patients treated with VDI from 2013 to 2018. VDI was indicated for stones <6mm in first-line treatment or for residual fragments <6mm after ureteroscopy, PCNL, microPCNL. The protocol included 4 sessions in outpatient care from 2013 to 2015 then 6 sessions from 2015 to 2018 and a final radiological evaluation., Results: In total, 109 patients or 489 sessions are reported: median age was 55 years [14-84], median BMI 25kg/m 2 [15-37], average cumulative size of kidney stones 3mm ±4. VDI was performed after flexible ureteroscopy (62%), SWL (20%), percutaneous treatment (9%) or as a first-line treatment (9%). Compliance was 87 %. The median VAS during the session was 0[0-8]. The incidence of post-session renal colic was 4% (all Clavien I). The postoperative fragment-free and microfragment rates were respectively 39% and 21%, i.e. an overall success of 60% for kidney stones, and 43% and 21%, i.e. an overall success of 64% for lower pole kidney stones., Conclusion: VDI is a simple, non invasive and well tolerated technique for the elimination of small renal lithiasis after SWL, ureteroscopy, PCNL or as a first-line treatment., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Purpose: To report the multi-institutional outcomes of Microperc for nephrolithiasis and to assess its feasibility in outpatient care., Methods: We retrospectively identified all adult patients who underwent Microperc for renal stones at three centres between May 2015 and March 2021. Interventions were performed by three Surgeons. One Surgeon adopted a "one-way" strategy and all Microperc were performed on an outpatient basis, while the other two Surgeons provided inpatient monitoring for at least one day after surgery. The primary endpoint was same-day discharge after Microperc without emergency department visits or unplanned readmission within 30 days of the procedure. The secondary endpoints included treatment outcomes and the 30-day complication rate., Results: Out of 72 consecutive patients included, 32 patients (44.4%) had same-day discharge. Median Charlson score (1 [0-2]) and cumulative stone size (15 [12-20] mm) were comparable between both groups. At one month post procedure, 32 patients (44.4%) were stone free and 23 patients (32%) had residual micro-fragments<3mm, conferring an overall success rate of 76.4% (inpatient Microperc group: 77.5% vs outpatient Microperc group: 75%, P=1). Analysis of the 30-day complication rate showed similar results between the two groups (Clavien I-II: 18.1%, Clavien≥III: 4.1%). After outpatient care, the rate of immediate admission and unplanned readmission was 12.5% (n=4), mainly due to urinary tract infection., Conclusion: In this multi-institutional study, we report that outpatient Microperc is feasible in selected patients with no significant impact on postoperative outcome., (Copyright © 2022. Published by Elsevier Masson SAS.)

Objective: To report the effectiveness, reliability and learning curve of Microperc, a minimal invasive percutaneous technique using a 4.85-Ch (16-gauge) sheath, in the treatment of nephrolithiasis., Material and Methods: 31 consecutive Micropercs for nephrolithiasis<2.5cm were performed by 2 operators in 2 different institutions from the 1st of May 2015 to 31st of December 2017., Results: The mean size of stones was 19mm±11mm, and mean density was 1048±249UH. Stones were located in lower calyx in 21/31(68%), medium calyx in 3/31(10%), pelvis in 4/31(12%) and were multi-caliceal in 3/31(10%). Five patients (16%) had urinary diversion (4 ileal conduits, 1 enterocystoplasty with Mitrofanoff+bladder neck closure) all of those having neurological disease (2 multiple sclerosis, 3 spinal cord injury). Mean operating time was 83±35min and decreased after short period for both operators. 9/31(29%) patients had complication: 8 (26%) had fever (Clavien II) and 1 (3%) had renal colic pain (Clavien III) (required JJ stent). Stone-free was obtained in 13/31(42%) and 11/31(36%) had residual microfragments<3mm which did not require further treatment, corresponding to a technical success of 78% (24/31). Success rate was similar in patients with urinary diversion and patients with normal anatomy., Conclusions: This study showed that Microperc was an effective technic for kidney stone treatment with low complication rate, acceptable operating time and short learning curve. Microperc was useful for stones in the lower calyx and/or urinary diversion where retrograde ureteroscopy could reach its limits., Level of Evidence: 3., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: Urinary tract infection (UTI) is a common complication after flexible ureteroscopy (fURS) despite technical precautions to avoid infectious complications. The aim was to investigate incidence and predictive risk factors of UTI following fURS procedure., Patients and Methods: We conducted a retrospective study including consecutive fURS performed in our center from January 2015 to March 2019. The indications were: nephrolithiasis management and diagnosis and conservative treatment of upper urinary tract urothelial carcinomas (UTUC). Since 2015, we had technical precautions to avoid postoperative infectious complications: centralized collection of preoperative urine cultures which are examined daily by an urologist and a service provider, systematic use of ureteral access sheath and application of standardized antibiotic prophylaxis measures. The primary endpoint was occurrence of UTI within 15 days following fURS., Results: Six hundred and four fURS were included for nephrolithiasis (n = 462) and UTUC management (n = 142). The median (IQR) age in the study cohort was 61(48-68) years, 268 female patients were included (44.4%), the median (IQR) Charlson score was 2(1-4) and single-use fURS were used in 186 cases (30.8%). Postoperative UTI occurred in 41 cases (6.7%). In multivariate analysis, female gender (OR 2.20 [1.02-5.02], p = 0.04), UTI within the last 6 months (OR 2.34 [1.12-5.11], p = 0.02), preoperative polymicrobial urine culture (OR 4.53 [1.99-10.56], p < 0.001) and increased operative time (OR 1.02 [1.002-1.031], p = 0.02) remain associated with postoperative UTI., Conclusions: In a large cohort study, female gender, prior UTI, increased operative time and preoperative polymicrobial urine culture were associated with the occurrence of postoperative UTI. Limiting operative time and improving our knowledge of polymicrobial urine cultures could reduce the infectious risk.

Introduction: Despite many advances, the management of renal stones - especially lower caliceal stones (LCS) - remains a challenge. The gravity-dependent location of the lower calices hinders the spontaneous clearance of fragments, which can be a nidus for future growth and symptomatic recurrence. Currently, there is no standard adjunctive therapy to facilitate fragment passage., Objectives: To report the safety and effectiveness of mechanical percussion diuresis and inversion (PDI) therapy for eliminating renal stones in children., Patients and Methods: Since November 2013, children with residual fragments (after shock wave lithotripsy or flexible ureteroscopy) or native symptomatic renal stones were prospectively included in a protocol of four PDI sessions. After giving written consent, the children drank 10 ml/kg of water 30 min before therapy. They then laid in a prone Trendelenburg position on a couch angled at 45° and received continuous 10-min mechanical percussion applied over the affected flank by a physiotherapist (Figure summary). Tolerance stone burden reduction and stone clearance were documented with ultrasound 4 weeks after the last session., Results: Seventeen participants, with a median age of 10.8 years (range 18 months to 18 years), received 82 PDI sessions performed over 22 months. The median stone diameter was 5 mm (range 3-9). All children tolerated the PDI therapy well. Over a median follow-up of 11 months (range 3-18), no significant adverse effects were noted. The overall stone-free rate was 65%. Four of the six patients with residual fragment passed their fragments. The patients who did not become stone free by PDI experienced a decrease in fragment size of 57% (range 34-71). The observance rate was 100%., Discussion: Many studies have demonstrated that the gravity-dependent position of the lower calyces appears to be an important factor limiting the clearance of LCS. Positioning patients with a degree of inversion in order to put the collecting system beyond the horizontal plane affected the LCS through gravitational force. Complications were rare. PDI appeared to save costs and have similar success rates as shock wave lithotripsy for native small renal stones in children., Conclusion: PDI is safe and effective for facilitating gravity-dependent drainage of renal stones and provides an opportunity to treat children in a quick, non-invasive, economic, painless, non-radiative and diverting fashion. This therapy is a valuable alternative in the pattern of stone management. In case of persistent fragments, it is recommend that the number of sessions be increased to six., (Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: The flexible ureterorenoscopy coupled with photovaporisation LASER (USSR-L) for the treatment of kidney kidney is a modern tool whose place is under evaluation., Methods: Its place has been assessed in France in 2010 by the Committee of urolithiasis of the French Association of Urology (CLAFU). A practice survey among 27 experts concerned the following decision criteria: comorbid patient's supposed nature of the calculation, anatomy of the urinary tract of the patient. This investigation has been proposed to calculate the size not exceeding 20mm, for a calculation of size greater than 20mm and for multiple calculations kidney., Results: Fourteen experts responded. The criteria for the USSR-The first line were: morbid obesity (BMI>30), anticoagulation or anti platelet aggregation, calculations Hard (UH>1000, cystine stones), calculations within diverticular caliceal calculations below, the failure of a first treatment or the wish of the patient., Conclusion: The URS-SL was a first-line treatment validated regardless of size and number of kidney stones, when ESWL and PCNL were contraindicated or when their predictable results were poor (hard stones/morbid obesity/lower pole stones) or when stone access is difficult (intradiverticular). It was also the treatment of choice after the failure of a first treatment (ESWL/PCNL)., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

With the endourological development, the management of urinary tract calculi in children has significantly improved. The miniaturization of endoscopic equipment has allowed the use of flexible ureteroscopic with holmium YAG laser lithotripsy in children. We highlighted the case of a 22-month-old child, with an antecedent of megaureter, who had calculi in the right kidney lower pole. In collaboration with the urologist specialising in adult care, using an adapted technical tray, we underwent a laser intracorporeal lithotripsy using a 8 Charriere (Ch) ureteroscope and an holmium laser. No ureteral dilatation was required. A complete fragmentation of this infectious calculus was performed. This experience with a flexible ureteroscopy confirms that this technique is practicable, efficient and safe for stone treatment in children., (2010. Published by Elsevier Masson SAS.)

It is recommended to treat staghorn calculi by percutaneous nephrolithotomy (PCNL) either alone or in combination with Extra Corporeal Shockwave Lithotrips (ESWL). Antegrade or retrograde fibroscopy, multiple accesses could also improve PCNL stone-free rates. ESWL alone is limited to partial staghorn calculi in adults or to staghorn calculi in children. Open surgery has more or less completely passed.

The management of renal stones needs a recent and good quality imaging. Contrast medium injection is optional. Extracorporeal shockwave lithotripsy (ESWL) is the most common treatment of renal stones. ESWL is indicated as first line treatment for less than 1.5cm stones. The stone-free (SF) rate at 3 months of ESWL is 70-80%. Results of ESWL for stones with more than 1000UH density or located in the lower calyx are poor. Flexible ureteroscopy (URS) is indicated in case of ESWL failure or for hyperdense, 1-2cm stones. The SF rate of flexible is 80%. Percutaneous nephrolithotomy is indicated for complex or more than 2cm stones. Asymptomatic and non infected stones, especially if located in the lower calyx, do not need urological treatment but must be followed up. In all cases, renal stones needs a metabolic evaluation and treatment, and annual follow-up.

Indication for ureteroscopy of an upper urinary tract stone depends on the location and size of the stone. For small proximal ureteral stones, first-line treatment is extracorporeal lithotripsy (ESWL). For big or distal ureteral stones, ureteroscopy (URS) is the more efficient urological treatment. URS has a higher morbidity than ESWL. URS must be careful, urines must be sterile, and a renal safety wire is mandatory. Ideal intracorporeal lithotripsy means are ballistic energy or holmium laser. Ureteral drainage is not always needed in case of easy monobloc removal of a small non impacted stone. In other cases an ureteral drainage is safer. The Stone Free rate of URS is 65-90%. The risk of ureteral stenosis is 1%.

Percutaneous nephrolithotomy has sometimes particular indications related to the patient, his anatomy or the stone itself. These situations will be described.

Tubeless PCNL has been promoted by Bellman in 1997 and consists in a PCNL without placing a nephrostomy tube at the end of the procedure. Double J stent or ureteral stent are the most common internal drainage used but totally tubeless PCNL has been described by using no ureteral stent. Tubeless PCNL is safe and efficient. Exclusion criteria to propose a tubeless procedure are significant bleeding or purulent renal discharge. Stone size or location, shape, position or function of the kidneys are also irrelevant with regard to tubeless PCNL. A nephrostomy tube should be placed if a second look is necessary. Some hemostatic agents have been described but none has really proved its efficacy. The results of the more recent series of the literature will be presented.

Renal lithiasis in renal donors is rare. A renal stone in a donor, or in a renal transplant, is not a contraindication for harvesting nor transplantation. If possible, the stone must be removed at the time of the transplantation. The risk of lithiasis is increased in the renal transplant recipient, with a frequency of 2-6%. Metabolic abnormalities for lithiasis are frequent and can be induced by the immunosuppressive treatment, anticalcineurins. Lithiasis can have a poor prognosis in the renal recipient with a risk for infection or renal dysfunction. Small (<4-5mm) stones in a renal transplant can be followed-up. Stones of 0.5-1.5cm need an extracorporeal lithotripsy with a previous safety JJ stent. Stones greater than 1.5cm can be treated by ureteroscopy or percutaneous surgery.

Open surgery for stones of the upper urinary tract has very few indications, failures or complications of other techniques, greater than 2cm stones, hard stones, anatomical abnormalities and complex stones. Open surgery for stone may be difficult and need specific tools. For the kidney, the anatrophic nephrotomy is an effective procedure which spares the renal function. For the ureter, the mini-ureterotomy is no more invasive than laparoscopy. The stone-free rate of open surgery is over 90%. The main complications are stenosis, fistula and infections.

Percutaneous access is a difficult step in percutaneous nephrolithotomy. Different methods have been described to facilitate percutaneous access. To increase stone-free rate, supracostal or multiple access is required. Indications, results and complications of these specific accesses are reviewed.

International classification of staghorn calculi is always lacking. French classification is described. Physiopatholgy of staghorn calculi is based on urinary infection. Staghorn stones in emerging countries will be composed frequently of calcium oxalate. Recurrent urinary infection and urinary stasis favour staghorn stone formation and are clinically significant. Medical treatment is rather uneffective. Only antibiotics and elimination of all residual fragments could be recommended.

Recent technological changes of percutaneous nephrolithotomy are reviewed. Results and complications of the most recent publications are presented.

Urinary lithiasis is an uncommon cause of chronic renal failure. Risky stones of chronic renal failure are cystinuria, tubular acidosis and chronic bowel diseases. Moreover, bilateral stones, late metabolic diagnosis and infection are factors that can induce an alteration of the renal function. Staghorn stone is a grave disease for the renal function and the life of the patient. There is no room for conservative treatment for staghorn stones. For solitary kidney, the stone treatment may improve the renal function. Incidence of stone in the dialysis population is 5-13%. In the dialysis population, it is recommended a yearly renal sonography and citrate, and magnesium treatment. All the urological procedures of stone removal are available in case of renal failure but the techniques must spare the renal function and avoid surgical complication. Urines must be with no infection and a urinary drainage is mandatory.

Since percutaneous nephrolithotomy (PCNL) was initially described, different technical modifications have been described. Among them, miniperc which only used small nephroscope and access sheath from 11 to 20Fr. This technique could not yet been recommended. Supine position is also a technical modification from original PCNL. Supine position is able to reduce colic injury and could be proposed in specific indications.

The review of the literature about ureteropelvic junction (UPJ) obstruction and concomitant renal stone has highlighted two major aspects. First, urinary stagnation due to UPJ obstruction is frequently associated with metabolic disorders such as hypercalciuria. Second, results of laparoscopic pyeloplasty are at least as good as those of open surgery but with the advantages of a minimal access approach. Exploration of the renal cavity with the laparoscope or a fibroscope allows to treat in the same time a concomitant renal calculi.

Stones in renal caliceal diverticula with no symptom or infection can be managed with surveillance. In other cases, extracorporeal lithotripsy (ESWL) can be the first line treatment for all diverticular stones, whatever their renal location. In case of ESWL failure, the procedure choice depends of the location of the diverticulum. Percutaneous surgery is indicated for lower and posterior diverticula. The puncture must be directly targeted to the stone. Flexible ureteroscopy is indicated for upper and mid, anterior or posterior, diverticula. Laparoscopy can be indicated for anterior, mid and lower or upper, diverticula. A medical evaluation and treatment must be systematic.

Laparoscopic approach is used to treat urinary lithiasis. Pyelolithotomy and ureterolithtomy being excluded from this review, indications for laparoscopy consist in treatment of calyceal diverticula, nephrectomy and/or ureterectomy for non-functioning kidneys, or laparoscopy-assisted percutaneous nephrolithotomy in ectopic kidney, horseshoe kidney or calyceal diverticula. Laparoscopy gives the benefits of a mini-invasive treatment with reduced blood loss, pain, hospital stay and recovery. In these indications, laparoscopy is still a skillfull demanding procedure.

The management of upper urinary tract stones needs an imaging for the diagnosis, the evaluation and the follow-up of the stones. The imaging has to be of good quality. For the simple acute flank pain, regular plain film with ultrasonography can be sufficient. For complex acute flank pain, a CT-scan with or without contract medium injection is mandatory. To plan the optimal treatment of the stone, injection of contrast medium is necessary if the diagnosis imaging is of poor quality. Imaging is systematically needed after the urological treatment of a stone. Regular plain film with ultrasonography is sufficient for the follow-up.

Renal stones can be treated by laparoscopic approach. Laparoscopy is used instead of open surgery which indications remains limited regarding high efficacy of ESWL or endoscopic procedures in urinary lithiasis. This review highlights that all open surgical procedures have been performed by laparoscopy, the most often being pyelolithotomy either by retroperitoneal or transperitoneal approach. These laparoscopic procedures are skillful demanding procedures. Robotic will probably increase a little bit laparoscopic approach to treat renal stones by its facilitating effect to perform suture.

Extracorporeal shockwave lithotripsy (ESWL) is the fragmentation of stone by means of acoustic shockwaves created by an extracorporeal source. ESWL brakes the stone by spallation and squeezing. The optimal frequency for fragmentation is 1Hz. The initial power must be low, then progressively increased during the session. The contra-indications for ESWL are pregnancy, major deformities, severe obesity, aortic aneurism, uncontrolled coagulation disorders, untreated urinary infection, cardiac pacemaker. A stone density of 1000UH is a risk factor for fragmentation failure. The success rate for the kidney and the ureter is 60-80% and 80%, respectively. Stone clearance may be facilitated by alpha blockers. Asymptomatic and non-infected residual fragments less than 4mm must be followed-up annually.

Flexible ureterorenoscopy combined with Holmium-YAG laser is an effective and reliable technique for the management of renal stones. Cacchi-Ricci disease is a frequent urological malformation characterized by precalyceal stone formation, for which no preventive treatment is available at the present time. Some complicated forms are difficult to manage because of the technical impossibility of treating these precalyceal stones. The objective of this article is to describe a technique allowing management of these precalyceal stones by flexible ureterorenoscopy combined with Holmium-YAG laser.

Flexible ureterorenoscopy is recommended for the treatment of inferior calyx stones, 10 to 15 mm in diameter, particularly after failure of extracorporeal lithotripsy. It is recommended to mobilize an inferior calyx stone towards the renal pelvis or superior calyx before starting fragmentation. This manoeuvre is essential to preserve the ureterorenoscope. The objective of this technical note is to explain the stone "relocalization" manoeuvre and describe how in situ treatment of an inferior calyx stone can be dangerous for the flexible ureterorenoscope.

Objective: Evaluation of the treatment of inferior caliceal stones by flexible ureterorenoscopy and Holinium-YAG laser on a series of 69 operations., Material and Method: Between April 1998 and December 2003, 69 flexible ureteroscopies were performed for 55 stones in 49 patients. The mean age of the patients was 51.6 years (range: 18-78). The mean stone diameter was 12.8 mm (range: 5-3 1). 46% of stones had been pretreated by ESWL, PCNL or surgery. Endocorporeal lithotripsy was performed by Holmium-YAG laser in 45 cases, Lithoclast in 5 cases and en bloc extraction in 3 cases. Technical features, efficacy and morbidity were studied. The results were classified into fragment-free (FS), residual fragments (RF) < or = 4 mm, RF > 4 mm and failures. The results were evaluated on D0-D1 and at 3 months on a plain abdominal x-ray and ultrasound., Results: The mean operating time was 61 minutes (range: 25-120). Nine stones required several procedures. 20% of stones were cystine stones. A ureteric stent was placed in 67 cases. The mean length of stay was 2.5 days (D0-D8). At 3 months, after one or several ureteroscopies, the results were: 22% FS, 40% RF < or = 4 mm, 13% RF > 4 mm and 25% failures. One half of failures occurred during the first 14 ureteroscopy procedures. There were 13 minor complications and no major complications., Conclusions: The results of flexible ureteroscopy in the treatment of inferior caliceal stones are encouraging, especially with standardization of the technique. It appears to be a good compromise between ESWL and PCNL, particularly for stones between 10 and 20 mm, cystine stones and after failure of reference techniques.

Introduction: Percutaneous nephrolithotomy (PCNL) in subjects over the age of 70 is considered to be associated with a higher risk than extracorporeal shock-wave lithotripsy (ESWL). However this technique is sometimes necessary for very large or complex stones in patients with several comorbidities., Study Objective: To evaluate the predictive factors of success and operative risks likely to influence the results of PCNL in a population of patients over the age of 70., Material and Method: Retrospective study of 203 patients (110 males, 97 females) over the age of 70, in whom a total of 210 PCNL were performed over a 12-year period in ten referral centres for the treatment of stones. 68.5% of cases presented a comorbidity and the median ASA score was 2. The median stone dimensions were 24 x 15 mm. There were 67 solitary pelvic stones, 7 infrapelvic ureteric stones, 31 solitary inferior caliceal stones, 40 complex stones and 13 staghorn calculi. A standard one-stage operative technique was performed in 92% of cases; the nephrostomy tract was easily performed by the urologists themselves in 71.8% of cases., Results: The overall stone-free (SF) rate was 70.8%. The patient's weight and height (p=0.03 and p=0.01), stone dimensions and their solitary nature were significant factors of success (p<0.00001 and p=0.01) with SF rates of 81.1% for pelvic stones and 90.3%for solitary inferior caliceal stones (p<0.003); the SF rate for complete staghorn calculi was only 30.8%. A history of stones (p=0.04) and diabetes (p=0.03) influenced the stone-free rate, but the other comorbidities, body mass index, and age did not influence the stone-free rate. There were two deaths (0.9% and haemostasis nephrectomy was performed in 2 ASA 3 subjects in renal failure. In the other patients, there was no difference between preoperative and postoperative serum creatinine and haemoglobin levels. The ease of nephrostomy, the rapidity of PCNL, the day of removal of the drainage nephrostomy, the mean hospital stay (median stay: 6 days), sterility of postoperative urine and at the 1-month visit were significantly correlated with the SF rate., Conclusions: PCNL in subjects over the age of 70 years is a safe and reliable technique that achieved a stone-free rate of 70.8% for all types of stones combined. The best results were obtained for solitary stones larger than 20 mm in the renal pelvis or inferior calyx. Apart from diabetes, which remains a risk factor, well controlled comorbidities do not increase the operative risk. PCNL did not affect haemodynamic parameters or renal function.

Purpose: To compare in a random fashion an automated irrigation/suction pump system with the standard pressurized technique during transurethral ureterorenolithotripsy., Patients and Methods: Between July 2001 and December 2001, 47 patients were prospectively included. Prior to randomization, rigid instruments were allocated to 25 patients (group R) and flexible instruments to 22 patients (group F) according to stone location. The groups R and F were then randomized separately, and the pressurized technique was employed in groups R1 and F1, while the automated system was employed in groups R2 and F2. Operative time, amount of liquid consumed, and stone-free rate at the end of the procedure were analyzed., Results: For the entire series, ureteroscopy time using the automated system (mean 42 +/- 17[SD] minutes; range 15-90 minutes) was 35% less than with the pressurized technique (mean 65 +/- 25 minutes; range 20-135 minutes) (P = 0.04 Wilcoxon score). The stone-free rate was significantly higher in groups R2 + F2 (92%) than in groups R1 + F1 (69%) (P = 0.048)., Conclusion: With the ENDO FMS UROLOGY system, there was a significant reduction in the mean ureteroscopy time: 32% less with the rigid instrument and 53% less with the flexible instrument. This seems to be attributable to a wider working space and highly improved visibility. The integrated suction at constant flow allows efficient evacuation of stone fragments while limiting cavity pressure. These results, obtained on 47 patients, should be confirmed by larger randomized studies.

Some renal calculi are borderline indications for either extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL). Our purpose was to quantify by single photon emission computed tomography (SPECT) the parenchymal lesions of these two procedures to make the choice easier. The SPECT study was done before and 30 days after the stone treatment. The scan was carried out 10 hours after injection of 99mTc-DMSA using a GE400 rotative gamma camera, which data were reconstructed in three planes. The local uptake and scar of the treated area were evaluated in 22 patients with symptomatic kidney stones without previous treatment or renal failure. Twelve patients (mean stone size 12 x 9 mm) were treated on a piezoelectric (EDAP LT-01) lithotripter (mean shock wave number 3420), and ten patients (mean stone size 24 x 17 mm) were treated by PCNL (32F Amplatz sheath in a lower calix). There were no complications, and the stone-free rate at day 30 was 50% in both groups. In the ESWL group, all of the kidneys demonstrated a loss of local uptake, whereas 7 of the 10 in the PCNL group did so. In the ESWL group, 4 of the 12 kidneys had a local loss exceeding 4% but only 2 of 10 kidneys in the PCNL group. There were 7 scars in the treated area in the ESWL group and 6 in the PCNL group. Extracorporeal lithotripsy does not seem to be a nontraumatic procedure for the kidney. For stones that would require several sessions of ESWL, the use of PCNL must be preferred.