RIRS procedure
After general anesthesia, Firstly semi-rigid ureteroscopy was performed
to evalute and actively dilate the ureter before flexible ureteroscopy.
Thereafter, a 12/14 Fr ureteral access sheath (UAS) ( Flexor
12/14Fr, Cook Medical Bloomington, IL, USA, Navigator 11/13Fr, Boston
Scientific, Natik, MA, USA ) was placed over the guidewire under
fluoroscopic guidance. All the RIRS were performed using Flex-X2 or
Flex-XC (Karl Storz Endoscope, Germany) through the ureteral access. If
UAS can not be placed, double J ureteral catheter was inserted to the
kidney collecting system for passive dilatation approximately 1-2 weeks
before re-surgery. The stones were fragmented using a 200/273 μm Holmium
laser fiber (Dornier Med-Tech GmbH, Medilas H20, Wessling, Germany).
Surgery was concluded after stone-free status (ureteroscopic inspection
and fluoroscopy), or detection of bleeding which blocked the surgeon’s
view or decision. When the AUS was withdrawn, the ureter was examined
with flexible ureteroscopy. If there were any injuries, DJ was applied
at the end of the procedure, according to surgeon’s judgment. DJ stent
was removed 2-3 weeks after surgery in all patients.
“Stone-free” status was defined as stones of less than 2 mm or no
evidence of stones on one-month postoperative CT.