Introduction and Objectives
In the past 25 years, the treatment of proximal ureteral lithiasis evolved from ureterolithotomy to extracorporeal shockwave lithotripsy and/or ureteroscopy. Our objective was to analyse, in a significant series, the results of retrograde ureteroscopy in proximal ureteral lithiasis.
Material and Methods
Between June 1994 and February 2009, in our clinical department 5102 patients underwent retrograde ureteroscopy (5534 ureteroscopic procedures). Upper urinary tract lithiasis was the main indication, which was used in 4562 cases. The proximal ureteral calculi were treated on 1238 cases, 442 and 796 being larger and respectively smaller than 1 cm.
The stone-free rate after one procedure was 86.5%. According to stone size, the success rates were 81.9% for calculi over 1 cm and 88.9% for stones smaller than 1 cm. Treatment failures were related to ascending migration of stone fragments (7.2%), impossible approach of the calculus (5.2%) and aborting the procedure due to complications (1.1%). The intraoperative incidents occurred in 1.3% of the cases: fixed stone extractors (0.6%), equipment damages (0.4%) or JJ stent malpositioning (0.3%). The incidence of intraoperative complications was 3.4%: mucosal abrasion (1.4%), false passage (1%), ureteric perforation (0.5%), extra-ureteral stone migration (0.1%), bleeding (0.1%), ureteric avulsions (0.2%). Early complications were described in 10.2%. We also found late complications such as ureteral stenosis (2 cases) and persistent vesico-ureteral reflux (1 case).
According to our experience, ureteroscopy represents a valuable option in proximal ureteral lithiasis treatment with high stone-free rates and minimum morbidity.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.