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Clinical Trial
. 2015 Jan;193(1):165-9.
doi: 10.1016/j.juro.2014.07.002. Epub 2014 Jul 9.

A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm

Elias S Hyams  1 , Manoj Monga  2 , Margaret S Pearle  3 , Jodi A Antonelli  3 , Michelle J Semins  4 , Dean G Assimos  5 , James E Lingeman  6 , Vernon M Pais Jr  1 , Glenn M Preminger  7 , Michael E Lipkin  7 , Brian H Eisner  8 , Ojas Shah  9 , Roger L Sur  10 , Patrick W Mufarrij  11 , Brian R Matlaga  12
Affiliations
Clinical Trial

A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm

Elias S Hyams et al. J Urol. 2015 Jan.

Abstract

Purpose: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.

Materials and methods: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 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 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.

Conclusions: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.

Keywords: calculi; diagnostic imaging; kidney; ureter; ureteroscopy.

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References

    1. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 Guideline for the management of ureteral calculi. J Urol. 2007;178:2418. - PubMed
    1. Aboumarzouk OM, Kata SG, Keeley FX, et al. Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteral calculi. Cochrane Database Syst Rev. 2012;5:CD006029. - PMC - PubMed
    1. Kijvikai K, Haleblian GE, Preminger GM, et al. Shock wave lithotripsy or ureteroscopy for the management of proximal ureteral calculi: an old discussion revisited. J Urol. 2007;178:1157. - PubMed
    1. Castro EP, Osther PJS, Jinga V, et al. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society Ureteroscopy Global Study. Eur Urol. 2014;66:102. - PubMed
    1. Matlaga BR, Jansen JP, Meckley LM, et al. Treatment of ureteral and renal stones: a systematic review and meta-analysis of randomized, controlled trials. J Urol. 2012;188:130. - PMC - PubMed

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