Autologous blood coagulum for fragment removal after ureteroscopic laser lithotripsy

Tiffany R. Huang^1,*, Bruce M. Gao¹, Aymon Ali¹, Mariah C. Hernandez¹, Christopher D. Yang¹, Jonathan Badin-Castro¹, Carol Davis-Dao^1,2, Helen Gao¹, Seyedamirvala Saadat¹, Seyed Amiryaghoub M. Lavasani¹, Sohrab N. Ali¹, Pengbo Jiang¹, Roshan M. Patel¹, Jaime Landman¹, Ralph V. Clayman^1,*
1 Department of Urology, University of California, Irvine, Orange, CA, USA
2 Division of Pediatric Urology, Children’s Hospital of Orange County, Orange, CA, USA
* Corresponding Author: Tiffany R. Huang. Email: email ; Ralph V. Clayman. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.077477

Received 10 December 2025; Accepted 12 March 2026; Published online 10 April 2026

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Abstract

Background: Ureteroscopy is the recommended surgical treatment for renal stones less than two centimeters in diameter but often leaves residual fragments, increasing the risk of stone recurrence. Autologous blood coagulum is a potential adjunct to ureteroscopy for aiding fragment retrieval. This study evaluates the efficacy and efficiency of autologous blood coagulum assisted ureteroscopy compared to ureteroscopy and basketing for achieving absolute stone-free Grade A status. Methods: Following Institutional Review Board approval, a retrospective review of our comprehensive UC Irvine Minimally Invasive Surgery Ureteroscopy database consisting of 962 patients undergoing ureteroscopy between 2018 to 2025 identified 15 renal units treated with ureteroscopy plus autologous blood coagulum and 47 matched controls treated with standard ureteroscopy and basketing alone. Primary outcomes included absolute stone-free status and stone-free rate, with operative time as a secondary outcome. Multivariate logistic regression was used to determine factors most closely associated with stone-free status. Results: Autologous blood coagulum increased the proportion of patients achieving absolute stone-free Grade A status (60% vs. 19%; p = 0.007) and was associated with a greater odds of achieving Grade A status compared to standard ureteroscopy (OR = 4.6; 95% CI = 1.04–20.1; p = 0.044). In patients who received autologous blood coagulum, thulium laser use was associated with a significantly greater odds of achieving Grade A status (OR 6.7; 95% CI: 1.1−39; p = 0.047). There was no significant difference in the relative stone free rates for fragments ≤4 mm (Grades A+B+C) between groups (73% vs. 60%; p = 0.38). Mean operative time for autologous blood coagulum vs. the control group was comparable (141.1 vs. 135.1 min; p = 0.76). Conclusions: Autologous blood coagulum is an effective adjunctive technique to standard ureteroscopy that enhances stone-free outcomes without prolonging operative duration or requiring any additional equipment or expense.