Introduction and Objectives
Initial treatment options for patients with ureteral stones who require active stone removal are both extracorporeal shock-wave lithotripsy (SWL) and ureterorenoscopy (URS). SWL is usually described as less invasive and safer, but URS has lower retreatment rate. The aim of this retrospective study was to present our results of URS in treating ureteral calculi and to analyze stone-free and complication rates, along with auxiliary procedures performed.
Material and Methods
We present the analysis of 210 URS treatments, the first portion of a larger scale study of 587 URS procedures performed at our Department from 1987 to 2008. URS was performed with Storz semirigid ureterorenoscope, using mostly electrokinetic and rarely ultrasonic lithotripsy. Mean age of the patients was 54±13.4 years (age±SD), range 12–82 years, with male to female ratio of 0.93. Location of the stones was proximal in 21.9%, mid-ureteric in 29.5% and distal in 48.6% of the cases. Median stone size was 10mm (range 2–90 mm). Comorbidities were present in 58% of the patients, among which arterial hypertension was most common (74.6%). 51% of the patients had previously undergone SWL treatment of observed ureteral calculi. Stone-free rate (SFR) was determined as complete abscence of stone fragments on plain abdominal film and ultrasonography after URS treatment.
Overall SFR was 77.14%, with 58.7% for proximal, 79% for mid-ureteric and 84.3% for distal calculi. JJ stent placement during procedure was required in 41% of the patients. In 58.3% of non stone-free patients additional SWL session was sufficient for complete stone clearance, with modified overall SFR of 90.5%. The rest of the non stone-free patients had clinically insignificant residual fragments and were monitored in later follow-up, failed to show at the check-up or had undergone several SWL sessions. Complications were noted in 23 patients: 13 patients had fever, 6 required percutaneous nephrostomy and 4 open surgery.
We perform primary URS in younger patients and the high percentage of pre-URS SWL treatments of ureteral calculi is due to patients’ age, comorbidities and avoidance of anesthesia. Nevertheless, URS showed to be safe and effective in removing ureteral stones, with additional SWL session when no spontaneous passage of the residual fragments occured.We also reduced the number of stenting after uncomplicated URS and the trend is for URS to become the initial modality of ureteral stones removal because of its low retreatment and complication rate.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.