To evaluate the efficacy and operation skills of the flexible ureteroscopy with Holmium laser lithotripsy for renal and upper ureter calculi.

From Jul. 2014 to Sep. 2015, 46 cases of renal and upper ureter calculi(size between 10 to 25 mm in diameter), were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospital. A F5/F6 double-J stent was placed one week before operation. A rigid ureteroscopy was inserted to observe the ureteral lumen, then a Olympus F7.5 flexible ureteroscopy with Holmium laser lithotripsy was used to perform the procedure, and a F5/F6 double-J stent had been used at the end of procedure. When the insertion of rigid ureteroscopy and ureteric access sheath was difficult, the flexible ureteroscopy would be inserted directly via a guide-wire. A follow up by KUB was done 1 day after the procedure to evaluate the result. A follow up by KUB or non-contrast CT scan was done 28 days after the procedure to evaluate the results.

The insertion of flexible ureteroscopy was successful in 95.6% (44/46 )cases in the first time. The calculi were detected in 44 cases, and laser lithotripsy succeeded in 42 cases(95.4%). 38 cases out of 44 (90.5%) had stone clearance at 4 weeks after primary operation, and 3 cases undergone ESWL, the total stone clearance rate was 93.2%(41/44). The average operation time was 76 minutes(60 - 155 minutes). No serious complication occurred.

Flexible ureteroscopy combined with holmium laser lithotripsy is a safe and effective procedure for upper tract calculi, it is a better option for ESWL failed and PCNL residual calculi.