Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm

Abstract

Introduction and objective: Optimal management of large impacted proximal ureteral stones remains controversial. Retrograde ureteroscopy in these cases may be challenging due to the presence of mucosal edema and inflammation, tortuousity and unusual angulations of the ureter. The objective of this study is to evaluate the efficacy and safety of retrograde ureteroscopy (URS) for the treatment of impacted proximal ureteral stones larger than 10 mm. Material and methods: A prospectively collected database of 143 patients, who underwent retrograde ureteroscopy for impacted proximal ureteral stones ≥ 10 mm between January 2016 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates, complications and auxiliary procedures was analyzed. Results: Patients’ mean age was 54.2±13.4 years, and male-to-female ratio – 67.8%/32.2%. Mean stone length was 14.2±5.4 mm and mean stone width – 9.6±2.9 mm. 26 (18.2%) patients were on preoperative anticoagulation therapy, which could not be discontinued. 26 patients (18.2%) had preoperative drainage with ureteral stent JJ, and 7 (4.9%) – with percutaneous nephrostomy. Stone-free rate after single procedure was 88.8%. Mean operative time was 44.2±15.4 min. There were no cases of failed endoscopic access to the stone. Flexible ureteroscopy was performed in 34 (23.8%) cases. Postoperative drainage was ureteral stent JJ in 71 (49.7%) patients and ureteral catheter for 24 h – in 33 (23.1%). Most common postoperative complications were fever in 5 (3.5%) and postoperative renal colic – in 5 (3.5%) patients. 8 patients (5.6%) underwent SWL for treatment of residual fragments and 2 (1.4%) – retrograde intrarenal surgery. Conclusions: The results from this study demonstrate that retrograde ureteroscopy is an effective and safe treatment modality for impacted proximal ureteral stones ≥ 10 mm. Its high stone-free rate and low complication rate make retrograde URS a suitable first-line treatment for anticoagulated patients with impacted proximal ureteral stones, who are at increased risk of complications from the antegrade approach