Abstract：Objective: To evaluate the approach and safety of flexible ureteroscopic holmium laser incision and internal drainge in semisupine lithotomy position for renal cystic disease. Methods: From March 2013 to January 2018, clinical data of 32 patients with renal cystic disease were retrospectively reviewed, including 16 cases of simple renal cyst, 13 cases of peripelvic renal cyst and 3 cases of caliceal diverticulum. Of all the patients, 19 were males and 13 were females. The mean age was 45.7 years (ranging 23-71 years). The mean diameter of cysts was 5.4 cm (ranging 4.5-11.0 cm) and the mean diameter of calculi was 1.1 cm (ranging 0.8-1.4 cm). In regards to 3 cases of caliceal diverticulum, 2 cases were noticed with calculi and 1 case with renal milk of calcium. All patients received intravenous urography or CT urography preoperatively and underwent double-J stent placement 2 weeks before operations. These patients had undergone holmium laser incision and internal drainage in semisupine lithotomy position for renal cystic disease by using flexible ureteroscope under general anaesthesia, and had received double-J stent placement after operations. During the operation, holmium laser was retrogradely used to incise the convex thin walls of renal cystic cavity or caliceal diverticuluar necks. Results: Surgical operations were performed successfully on all patients, the mean operative time was 52.3 min (ranging 30-85 min) and the mean hospital stay was 5.2 days (ranging 4-7 days). There were no severe complications such as postoperative delayed hemorrhage, urosepsis, ureteral perforation, impairment of renal function. After the follow-up of 6-24 months, renal cystic cavity disappeared in 25 patients and was significantly reduced in 7 patients. Among them, there were 3 cases whose caliceal diverticulum disappeared and symptoms relieved after operations. The calculi and renal milk of calcium were removed. Conclusions: On the premise of accurate evaluation of imaging and creating reasonable treatment measures, flexible ureteroscopic holmium laser incision and internal drainge in semisupine lithotomy position is a safe and effective method for renal cystic disease.
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