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• W2344504059 abstract "Recent advances in flexible ureteroscopy, as well as the development of various accessories and the implementation of Holmium laser as a fragmentation mechanism, consisting of flexible retrograde laser nephrolithotomy (FRLN), is an attractive alternative for the management of large lithiasic masses. The analysis of the evidence available to date is essential to establish the benefits and limitations compared to other therapies, such as percutaneous nephrolithotomy. A systematic search was performed in MEDLINE and SCIENCEDIRECT data bases. The search was limited by language to articles published in English and Spanish, and limited in time to articles published in the last 10 years. A total of 30 articles of interest to the topic and a case report on a large lithiasic mass handled with FRLN are included. Percutaneous nephrolithotomy is considered the gold standard for the management of renal stones larger than 2 cm, with stone free rates of 76–95% with 1.9 procedures. However, complication rates have been reported between 8 and 45%, and decreased GFR between 9 and 34% was recorded in the post-operative period. On the other hand FRLN provides an stone free rates of 86–95% in about 1.6 procedures, and complication rates ranging from 10 to 20%. The FRLN has become an effective alternative for the management of large lithiasic masses, with stone free rates similar to those obtained with percutaneous nephrolithotomy, but with fewer complications. Its usefulness is most evident in special cases, such as large stones associated with significant comorbidity, obesity, failure renal, spinal malformations, or a single kidney. Los recientes avances en la ureteroscopia flexible, como el desarrollo de diversos accesorios y la aparición del láser holmio como mecanismo de fragmentación, hacen de la nefrolitotomía retrógrada flexible láser (NRFL) una alternativa atractiva para el manejo de grandes masas litiásicas. El análisis de la evidencia disponible hasta el momento resulta fundamental para establecer sus beneficios y limitaciones frente a terapias establecidas como la nefrolitotomía percutánea. Se realizó una búsqueda sistemática en bases de datos MEDLINE y SCIENCEDIRECT. La búsqueda fue limitada por idioma para artículos publicados en inglés y español, y limitada en tiempo para artículos publicados en los últimos 10 años. Se incluyen 30 artículos de interés para el tema y el reporte de caso de gran masa litiásica manejada con NRFL. La nefrolitotomía percutánea es considerada el patrón de oro para el manejo de cálculos renales mayores de 2 cm con tasas libres de cálculo del 76–95% con 1,9 procedimientos, sin embargo, las tasas de complicación se han descrito entre el 8–45%, y la disminución de la TFG en el periodo postoperatorio se ha registrado entre 9–34%. Por otro lado la NRFL ofrece tasas libres de cálculo del 86–95% con 1,6 procedimientos, y tasas de complicación que oscilan entre el 10–20%. La NRFL se convierte en una alternativa eficaz para el manejo de grandes masas litiásicas con tasas libres de cálculo similares a las obtenidas con nefrolitotomía percutánea aunque con menor índice de complicaciones; su utilidad es más evidente en casos especiales tales como cálculos grandes asociados a comorbilidad importante, obesidad, falla renal, malformaciones óseas, espinales o riñón único." @default.
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• W2344504059 date "2016-05-01" @default.
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• W2344504059 title "Retrograde flexible nephrolithotomy in the management of large lithiasic masses as an alternative to percutaneous nephrolithotomy" @default.
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• W2344504059 doi "https://doi.org/10.1016/j.uroco.2016.04.003" @default.
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