Another approach to treat large renal pelvis calculi: presetting a double J tube and ureteroscopic lithotripsy through ureteral access sheath

Abstract Objective: To evaluate a new approach to treat renal pelvis calculi. Patients with large renal pelvis calculi who were deemed inappropriate to undergo percutaneous nephrolithotomy (PCNL) were treated by presetting a double J tube and ureteroscopic lithotripsy through ureteral access sheath (UAS). Methods: We retrospectively reviewed clinical data from 130 cases where patients had 2-3cm renal pelvis calculi with mild hydronephrosis (separation of renal pelvis ≤20mm) from January 2017 to January 2022 and divided them into three groups. In group A, 36 patients were treated by presetting a double J tube as stage I surgery, rigid ureteroscopic lithotripsy (URL) and flexible ureteroscopic lithotripsy (FURL) through ureteral access sheath as stage II surgery. In this group, URL was mainly used to break calculi and FURL was occasionally used to seek smaller calculi if required. In group B, 31 patients were treated URL alone. In group C, 63 patients were treated with single-tract mini-PCNL. The calculi clearance rate, operation time, hospitalization days, hospital costs and complications between the groups were compared. Results: The calculi clearance rate in group A was 80.56%, group B 74.19% and group C 84.13%, and the difference was not statistically significant (P>0.05). The operation time of group A was (93.94±14.22) min, group B (104.87±13.42) min and group C (82.63±18.39) min, and there were significant differences between group B and both group A and group C (P<0.05). The hospitalization days of group A were (2.63±0.58) d, group B (3.47±1.01) d, and group C (4.58±1.58) d, and there were significant differences between group A and both group B and group C (P< 0.05). In group C, there were 2 cases of bleeding which were remedied with conservative treatment. Conclusion: For patients with 2-3cm renal pelvis calculi and mild hydronephrosis, the treatment of presetting a double J tube and ureteroscopic lithotripsy through ureteral access sheath has the advantages of less trauma, less hospitalization days and a lower complication rate. The new method has reliable calculi clearance rate, higher lithotripsy efficiency and lower economic cost than FURL alone.