TAIPEI, TAIWAN ( - Introduction and Objectives: To assess the efficacy and safety of ureteroscopy-assisted Directional-eFlow (DeFlow) Doppler ultrasound-guided mini-endoscopic combined intrarenal surgery (mini-ECIRS) for large renal stones.

wceMethods: From May 2013 to April 2014, 16 patients with large renal stones of ≥2 cm in diameter underwent D-eFlow Doppler ultrasound-guided (ALOKAa7) mini-ECIRS in our institution. All mini-ECIRS procedures were performed under general anesthesia with patients in a modified-Valdivia position. Stones were fragmented using a Holmium laser, miniature nephroscope, and flexible ureteroscope, then extracted with a basket.

Results: The study included 16 patients (8 male, 8 female) with a mean age of 56.9 +/- 12.1 years. The collecting system was successfully accessed using a single tract in all cases. Mean stone size was 44.4 +/- 18.8 mm, including one complete staghorn calculus and two partial staghorn calculi. The mean total operative and mini-ECIRS times were 145.5 +/- 26 min and 96.0 +/- 17.1 min, respectively. The stone-free rate on postoperative Day 1 (POD1) was 81.2%. At one month, following auxiliary procedures, the stone-free rate increased to 93.7%. The mean hemoglobin decrease was 0.38 +/- 0.7 g/dl. Only minor intraoperative and postoperative complications occurred (fever ≥38.5, transfusion, and perirenal hematoma on POD1: 0%), including one case of post-discharge pyelonephritis.

Conclusions: Ureteroscopy-assisted Directional-eFlow Doppler ultrasound-guided mini-ECIRS was efficient and safe for treating large renal stones. The use of Directional-eFlow Doppler ultrasound guidance for selecting the puncture line into the renal parenchyma may minimize bleeding. However, treating larger renal stones with mini-ECIRS using a Holmium laser may result in a longer operative time associated with miniature nephroscope use.

Source of Funding: None

Listen to an interview with Takaaki Inoue, one of the authors of this study.


Presented by Takaaki Inoue,1 Takashi Murota,1 Makoto Taguchi,1 Tomoyuki Hayashi,1 Teruhisa Nishida,1 Shigenari Kawakita,1 Takashi Kawabata,1 Kouei Muguruma,1 Hidefumi Kinoshita,2 and Tadashi Matsuda1 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

1Takii-Hospital in Kansai Medical University, Japan
2Hirakata-Hospital in Kansai Medical University, Japan


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