Abstract
It is almost impossible to estimate a stone's composition preoperatively, yet there is no question that it plays a great role in the difficulty of an endoscopic lithotripsy. One hundred and sixty patients have been treated with endoscopic access to their upper urinary tract and laser lithotripsy. All calculi were fragmented successfully with the pulsed-dye laser (Pulsolith). In 59 consecutive patients, an estimate of calculus composition was made endoscopically, in 46 of whom sufficient stone fragments were retrieved for crystallographic analysis. Twentytwo patients were felt to have either pure (>90%) or mixed (>50%) calcium oxalate monohydrate stone exteriors at the time of endoscopy, and in all these patients, the final stone analysis agreed with the endoscopic assessment. Endoscopic assessment of calcium oxalate dihydrate, uric acid, and struvite/calcium oxalate phosphate stones was also found to be accurate on final stone analysis. Overall, there was a 89% success rate in estimating stone composition endoscopically.
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