ARF caused by impacted ureteral calculi cleared with ureteroscopy and laser lithotripsy.
Emergency ureteroscopy and holmium:yttrium-aluminum-garnet (Ho:YAG) laser lithotripsy can be safely and successfully used to treat acute renal failure (ARF) caused by impacted ureteral calculi, according to researchers.
Investigators at Huashan Hospital, in Shanghai, studied 27 patients with acute post-renal failure. Impact calculi were present in both ureters of 22 patients with two kidneys, and in one ureter of five patients with a solitary or single-functioning kidney.
The presence of oliguria or anuria and a significant increase in serum creatinine and blood urea nitrogen were used to diagnose ARF. Patients were treated emergently with ureteroscopy and Ho:YAG laser lithotripsy in the hospital within 24 hours of presentation. Ureteral stenting was performed in all cases.
Postoperative renal function, electrolytes, and urine volume were monitored daily for seven days. Radiography and/or ultrasonography were performed at a follow-up visit four weeks later.
The procedures were performed successfully in all patients, the researchers reported in Urology (2008;72:504-507). The mean oper-ative time was 29.2 minutes (range 15-60 minutes). Of the 49 stones, 46 (93.9%) were successfully fragmented. The overall stone-free rate was 88.9%. Shock wave lithotripsy was used in three patients after recovery of renal function.
Normal renal function returned in 26 (96.3%) patients within seven days. Significant improvement in renal function occurred in one patient (3.7%), but function had not returned to normal at 12 weeks. No intraoperative complications or postoperative ureteral stricture occurred.