Role of Flexible Ureterorenoscope with Holmium Laser in Larger Renal Stones of Size 10-35mm

Background: Management of larger renal stones (10–35 mm) remains challenging, with percutaneous nephrolithotomy (PCNL) often considered the standard. This study aimed to evaluate the role of a flexible ureterorenoscope with a holmium laser in treating larger renal stones, specifically those measuring 10-35mm. Methods: This prospective study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from June 1, 2023, to May 30, 2024, after obtaining ethical approval. A total of 70 patients aged 18–65 years with renal stones sized 10–35 mm was included through non-probability consecutive sampling. All patients underwent preoperative clinical assessment, laboratory investigations, and imaging. Procedures were performed by consultant urologists using flexible ureterorenoscopy with Holmium: YAG laser lithotripsy. Data were analyzed using SPSS version 26.0, with p ≤ 0.05 considered significant. Results: The patients were 60% male and had an average age of 44.8 ± 12.3 years. 18.7 mm was the average stone size. In 82.9% of instances, a ureteral access sheath was utilized, and the average operating time was 72.4 ± 18.2 minutes. At 4 weeks, 24.3% of patients had residual fragments larger than 2 mm, whereas 75.7% of patients were stone-free. Significant correlations were found between leftover pieces and larger stone size (p≤0.001), lower-pole placement (p≤0.003), and longer operative duration (p≤0.001). Conclusion: A safe and efficient minimally invasive procedure for kidney stones 10–35 mm in size, flexible ureterorenoscopy with a Holmium: YAG laser offers good stone-free rates and low morbidity, especially in properly chosen patients.