Analyse der Ergebnisse und Komplikationen der ureterorenoskopischen Steintherapie von 1998 bis 2008 unter Berücksichtigung des verwendeten Instrumentariums sowie der Steincharakteristika

Abstract

BACKGROUND AND PURPOSE: Urolithiasis is a common disease. The success of stone treatment depends considerably on the method of stone removal. Therefore, good knowledge of the most relevant techniques is essential. This study is about the endoscopic removal of calculi using a ureteroscope/ureterorenoscope. Stone-free rates, complications and possible influencing factors of success (e.g. location, size, and chemical components of the urinary stone, instruments) were analyzed.MATERIALS AND METHODS: 594 ureteroscopies for urinary stones in the ureter and renal pelvis were analyzed retrospectively. Primary and secondary ureteroscopy was performed between 1998 and 2008 in the Department of Urology, University of Goettingen, Germany. 509 patients were treated, among these 349 male and 160 female. The mean patient age was 49.8 years. Semirigid and flexible ureteroscopes were used. Search for remaining concrements was realized endoscopically and postoperatively with x-ray imaging.RESULTS: Complete removal of all ureteral stones in a single ureteroscopy was achieved in 81.6%. Calculi in renal pelvis and ureter combined were treated successfully in 70%. The stone-free rate in renal pelvis was 49.5%, in proximal ureter 65.3%, in middle ureter 76.1%, and in distal ureter 90%. Stones <=5 mm were completely removed in 77%, stones >5 mm and <=10 mm in 64.2%, and stones >10 mm in 32%. Significant complications occurred in 5.7% (19 ureteral perforations, 10 perforations of the renal pelvis, 2 ureteral avulsions, 2 bleedings with need of blood transfusion, 1 urosepsis).CONCLUSIONS: Ureteroscopic stone treatment is an effective method which has a moderate rate of complications. Urinary stones in distal ureter and concrements <=5 mm are treated with excellent immediate stone-free rates.