Article: Repeat Surgery After Ureteroscopic Laser Lithotripsy With Attempted Complete Extraction of Fragments: Long-term Follow-up

General search question: What affects the need for repeat lithotripsy?

Purpose of the study:

• Many previous studies have claimed that there is a high rate of repeat surgery: 21% to 27% within 120 days. Clinically insignificant residual fragments have been reported to be an issue and a cause of the repeat surgery. There was a discussion of the difference between treatment success; some stating that treatment success was being stone free and some stating that success was there even with fragments of 2-4 mm. Purpose of the study was to investigate the connection between repeat lithotripsy and residual stone fragments.

Results:

• 226 procedures were analyzed.
• 218 patients were included
• Average follow up time was 4.1 years
• Repeat surgery was found in 19 patients. 
• Factors NOT found to have an effect on repeat surgery: age, gender, side in which kidney stone was on, and stone location all had NO effect on need for repeat surgery. 
• The sum of stone lengths in preop (combined size, not single dimension) was found to have an impact on the need for repeat surgery. 
• The presence of residual fragments was found to correlate with the need for repeat surgery.
• Residual stone fragments that were >2 mm had an increased need of repeat surgery. This need of repeat surgery increased even further when stone fragments were >4 mm