Difficult Case: The Impacted Ureteral Stone

Abstract

An impacted stone is defined as a stone where a guidewire will not pass without ancillary measures and/or a stone that does not move when forceful irrigation is applied ureteroscopically. Ureteral stone impaction is known to cause a local inflammatory response in the ureteral wall, thus caution should be exercised during the treatment of impacted ureteral stones as they are at a high risk for ureteral perforation and can predispose to ureteral stricture. We recommend an antegrade ureteroscopic approach for impacted stones >10 mm and a retrograde approach for impacted ureteral stones <10 mm. There is limited role for shock wave lithotripsy for impacted ureteral stones. In this chapter we describe our step-by-step approach for the treatment of an impacted ureteral stone.