INTRODUCTION: Flexible ureteroscopy (URS) is rapidly becoming a first-line therapy for many with renal and ureteral stones.
However, the present understanding of treatment outcomes for patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones < 2 cm in order to better define clinical outcomes associated with this approach.
METHODS: Adult patients with proximal ureteral calculi < 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded. Flexible URS, Holmium laser lithotripsy, and ureteral stent placement was performed. Ureteral access sheath use, laser settings, and other details of peri- and postoperative management were based on individual surgeon preference. Stone clearance was determined by renal ultrasound and KUB results at 4-6 weeks postoperatively.
RESULTS: Of 71 patients, 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA score was 1 in 12 (16%), 2 in 41 (58%), 3 in 16 (23%), and 4 in 2 (3%). Mean BMI was 31.8 kg/m2. Mean stone size was 7.4mm (5-15). Mean surgical time was 60.3 minutes (15-148). Intraoperative complications occurred in 2 (2.8%) including mild ureteral trauma. Postoperative complications occurred in 6 (8.7%) including UTI (3), urinary retention (2), and flash pulmonary edema (1). The stone-free rate was 95%; for stones < 1cm, the stone-free rate was 100%.
CONCLUSIONS: Flexible URS is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones < 2 cm.
Written by:
Hyams ES, Monga M, Pearle MS, Antonelli JA, Semins MJ, Assimos DG, Lingeman JE, Pais VM Jr, Preminger GM, Lipkin ME, Eisner BH, Shah O, Sur RL, Mufarrij PW, Matlaga BR. Are you the author?
Dartmouth Hitchcock Medical Center, Lebanon, NH; Cleveland Clinic Foundation, Cleveland, OH; University of Texas Southwestern Medical Center, Dallas, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of Alabama Birmingham, Birmingham, AL; Indiana University Health, Indianapolis, IN; Duke University Medical Center, Durham, NC; Massachusetts General Hospital, Boston, MA; New York University Langone Medical Center, New York, NY; University of California San Diego, San Diego, CA; George Washington University Medical Center, Washington, DC; Johns Hopkins Medical Institutions, Baltimore, MD.
Reference: J Urol. 2014 Jul 8. pii: S0022-5347(14)03936-6.
doi: 10.1016/j.juro.2014.07.002
PubMed Abstract
PMID: 25014576
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