Purpose: To evaluate the feasibility and outcome of flexible ureteroscopic removal of small (<1-cm) asymptomatic renal stone(s) following rigid ureteroscopy for ureteral stones.
Patients and methods: Ten female and nineteen male patients underwent rigid ureteroscopy and holmium lasertripsy for removal of ureteral stone(s). All had asymptomatic renal stone(s) on the same side, which were then removed using flexible ureteroscopy. The renal stones were either removed intact with a tipless Nitinol basket or fragmented with the laser to small pieces (<2 mm), with basket removal of larger fragments. The number and size of stones, total operative time, added time needed for flexible ureteroscopy, and intraoperative and postoperative complications were recorded. Follow-up at 1 month included a plain abdominal film and renal ultrasonography or noncontrast CT scan.
Results: Fifty-six renal stones with a mean size of 5.7 mm were treated. Fourteen patients had stones on the right side, and 15 had stones on the left. The mean total operative time was 56.5 minutes, with a mean added time of 16.7 minutes for flexible ureteroscopy. Stones were removed intact in 18 patients and fragmented in 8 patients, resulting in an immediate success rate of 90%. There were three failures. One-month follow-up confirmed all patients were either stone-free or had residual fragments <2 mm in diameter, with no new-onset hydronephrosis.
Conclusions: Removal of small asymptomatic renal stones at the time of ureteroscopy for ureteral stones appears safe and effective and requires little additional operative time.