Safety and efficacy of flexible ureterorenoscopy and Holmium:YAG lithotripsy for intrarenal stones in anticoagulated cases

Purpose: We compared perioperative outcomes in patients undergoing ureterorenoscopy and Ho:YAG lithotripsy for renal calculi with or without anticoagulation. Materials and Methods: We reviewed the records of all patients undergoing flexible ureterorenoscopy and Ho:YAG lithotripsy for renal calculi at 2 institutions from 2001 to 2007. We identified 37 patients on anticoagulation with Coumadin (R), clopidogrel or aspirin in whom anticoagulation therapy was not discontinued before surgery. Data on the anticoagulation group were retrospectively compared to those on a contemporary matched cohort of 37 controls without anticoagulation who underwent a similar operative procedure. The 2 groups were compared with regard to the stone-free rate, and intraoperative and postoperative complications with specific reference to bleeding and thromboembolism. Results: The 2 groups were matched for stone size, stone location, number of stones, bilateral procedures and concomitant ureteral stones. Anticoagulation group patients were older (58.2 vs 50.4 years, p = 0.0209) and had a greater American Society of Anesthesiologists score (2.8 vs 1.9, p <0.0001) compared to the control group. No procedure had to be terminated in the anticoagulation group due to poor visibility from bleeding. The median postoperative hemoglobin decrease was greater in the anticoagulation group than in the control group (0.6 vs 0.2 gm/dl, p <0.0001). The stone-free rate (81.1% vs 78.4%, p = 0.7725), intraoperative complications (0% vs 3%, p = 0.3140), postoperative complications (11% vs 5%, p = 0.3943) and hemorrhagic or thromboembolic adverse events were comparable in the 2 groups. Conclusions: When necessary, ureterorenoscopy and Ho:YAG lithotripsy can be performed safely and efficaciously for renal calculi in patients on anticoagulation therapy without the need for perioperative manipulation.