Effect of holmium laser measured in computerized tomography on fragmentation in retrograde intrarenal surgery and ureterorenoscopy performed with holmium yag laser for treatment of kidney and ureter stones

Background: The urinary tract stone disease, the frequency of occurrence varies according to climate, ethnicity, genetics and diet habits. The recurrence rate of at least one lifetime of stone disease patients is about 50%. Computed tomography is gold standard in the evaluation of urinary system stone disease. It helps us to show many features of stone such as size, volume, and density. In urinary system stone disease treatment; Methods such as ESWL, URS, RIRS, PNL, open surgery and laparoscopic surgery are available. When determining the surgical method, stone size, stone volume, stone density and factors belonging to the patient should be evaluated. When the treatment modalities are determined, the duration of surgery, duration of scopy, duration of hospitalization, possible complications and success rate of treatment should not be forgotten. URS and RIRS with holmium laser is preferred because of short duration of stay, short surgical time, short scoping time and low complication. Our purpose in this study is; URS and RIRS treatment showed the use of the hounsfield unit to determine the success rate. Materials and Methods: In our study, there were 566 patients who had ureteroscopy and RIRS, including 186 women and 380 men. Age, gender, stone laterality, preop ESWL story, preop DJ story, genitourinary operation story, stone localization, stone size, stone density, stone volume, duration of operation, stone free and residual stone size were recorded. The data obtained were evaluated using IBM-SPSS statistical package program on a computer environment. A value of p <0.05 was considered significant. Result: 506 patients were considered stone free.In stone-free patients, stone density (HU) was found to be statistically significant in comparison of stone size, stone volume, and operation timewhich were p <0.05 in all three analyzes. Residual group hounsfield unit was higher than the value of stone free hounsfield unit. Conclusions: It is important to choose the method with the highest stone-freeness, the most comfortable for the patient and the least risky in the treatment of stone disease. We wanted to show that computerized tomography may be effective in determining the treatment method, besides being effective on the diagnosis. We demonstrated that hounsfield unit can be used to determine the surgical methodand the feasibility of URS and RIRS treatment, which is the reliable method used in is important to take into consideration that the possibility of residual stone may be high even if the stone size is small.