Flexible Ureteroscopy in Complex Renal Stone Disease: A Retrospective Cohort Study
Abstract
Objective: Flexible ureteroscopy is the standard treatment for renal calculi ≤2 cm in patients with normal anatomy; however, its role in anatomically complex kidneys, defined as an anatomical kidney abnormality, remains unclear. Our study evaluated stone-free rates (SFRs) and postoperative complications following flexible ureteroscopy in complex upper urinary tract stone disease.
Material and Methods: A retrospective review was conducted of 59 adult patients who underwent flexible ureteroscopy between 2016 and 2024 for stones associated with calyceal diverticula, horseshoe kidney, duplicated collecting systems, transplanted kidneys, or ectopic ureters. Primary outcomes included SFRs at 1 month and postoperative complications. The continuous and categorical variables were reported using descriptive statistics. Subgroup analysis was performed using SPSS Statistics version 25.
Results: A total of 59 patients were included: The most common condition was calyceal diverticulum (47 cases). Six cases of duplicated collecting systems, four cases of horseshoe kidneys, one case of ectopic ureter, and one case of transplanted kidney. Overall SFRs were 74.5% for calyceal diverticulum, 50% for horseshoe kidneys, and 50% for duplicated collecting systems. Both transplanted kidney and ectopic ureter cases achieved 100% SFRs. Stone size was the only significant predictor of residual stones in calyceal diverticulum (p-value=0.012). Complications were mainly infection, occurring most frequently in duplicated collecting systems.
Conclusion: Flexible ureteroscopy is a feasible and effective option for selected complex renal stone cases, with stone size being the key determinant of success.
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