Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

Jaap D. Legemate,Hidefumi Kinoshita,Willem Strijbos,Beat Roth,Tibet Erdogru,Tadashi Matsuda,Nienke J. Wijnstok,Judith Palacios-Ramos,Roberto M. Scarpa,Jean J. de la Rosette

doi:10.1007/s00345-017-2028-2

Abstract

PurposeTo describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.MethodsThe Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.ResultsOf the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.ConclusionsUreteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.

Highlights

Impacted ureteral stones are stones that remain unchanged at the same location for a prolonged time period causing local inflammation [1]
Information on stone impaction was missing for 87 patients, remaining 8543 patients for analysis. 2650 (31.0%) Patients were treated for impacted stones and 5893 (69.0%) for nonimpacted stones
A prior ureteroscopy within 6 months before the current ureterolithotripsy was performed in 2.9% in the impacted stone group and 3.5% in the non-impacted stone group (p = 0.15)

Summary

Introduction

Impacted ureteral stones are stones that remain unchanged at the same location for a prolonged time period causing local inflammation [1]. Confirmation of ureteral stone impaction can be done during ureteroscopy, displaying a stone enveloped in a, frequently, inflamed oedematous mucosa. Patients with impacted ureteral stones are considered to be at risk for a less effective initial treatment and a higher complication rate if compared with patients with non-impacted stones [2]. For the treatment of distal and mid-ureteral stones, ureteroscopy is the approach of choice. For proximal ureter stones

Objectives

Methods

Results

Discussion

Conclusion