[Flexible nephroscopy for upper urinary tract pathology]

Flexible nephroscopy was introduced in the Urological Department of Saint John Emergency Clinical Hospital in 2002 and rapidly became a routine procedure. During September 2002-October 2006, flexible nephroscopy was performed in 113 patients for: lithiasis (107 cases), uretero-pelvic junction stenosis (3 cases), caliceal diverticulum (1 case), caliceal urothelial tumors (2 cases). In all cases a 24F flexible nephroscope was used. The energy sources consisted in an electrohydraulic lithotripsy device or Ho:YAG/Nd:YAG lasers. The success rate in patients with lithiasis was 94.4%. Antegrade endopyelotomy was successfully performed in all 3 cases. Evaluation at 6, 12 and 18 months revealed a normal pyelocaliceal system in 2 cases and a significant reduction of hydronephrosis in the third one. In the patient with caliceal diverticulum, evaluation at 6 and 12 months described a large communication with the pyelocaliceal system and no lithiasis recurrence. No recurrences occurred in the patients with conservatively treated caliceal urothelial tumors. Minor complications were encountered in 7% of the cases. Flexible nephroscopy decreases the necessity for multiple access trajects, supracostal access trajects or multiple procedures, thus reducing the morbidity associated with percutaneous interventions.