Efficiency of contact ureterolithotripsy in treatment of proximal ureteral large stones

Abstract

Introduction . Currently, indications for intracorporeal lithotripsy of ureteral stones with sizes up to 10 mm inclusively of different localization are established. However, there is no consensus was reached on the preferences of this type of surgery over other existing one in the case of proximal ureteral obstruction by a stones greater than 10 mm in size. Endoscopic ureterolithotripsy is associated with existing studies on the effectiveness and safety of this method. Thus, it is important to continue conducting comparative studies in this direction. Materials and methods . 54 patients with proximal ureteral stones larger than 10 mm in size were investigated. All patients underwent Semi-Rigid Ureteroscopy and Laser Lithotripsy (SRULL) using a semi-rigid ureteroscope. Patients was stratified into several groups in accordance with the size of stones according to the actual AUA classification: group A (n - 46), the dimensions of ureteral stones from 11 to 20 mm inclusive and group B (n - 8), the size of stones over 20 mm. Criterion for the effectiveness of treatment was to achieve the "Stone Free" level after performing lithotripsy. Indicator of treatment failure was the impossibility of complete removal of ureteral stone within one surgical procedure without its expansion. Statistical data processing was performed using non-parametric data analysis methods applying the STATISTICA 10 (StatSoft Inc., USA) software package. Results. Larger stones compared to higher density. Obstruction symptoms such as hydronephrosis, nausea and vomiting, gross hematuria were more common with stones > 20 mm. Treatment duration in patient groups is similar despite differences in the number of complications and the incidence of postoperative ureteral stenting. At the same time, operation time depended on stone size and density. Surgery efficacy in patient groups was comparable and met 78.3% in group A versus 75.0% in group B. Conclusion. Inflammatory and destructive changes in the ureter wall are more common with stones greater than 20 mm, which affects the incidence of postoperative complications. Increasing the operation duration and frequency of proximal fragments' migration are determined by increasing of the stones' size and density. SRULL important feature is the lack of statistical difference in the effectiveness with the different sizes of stones. In addition, the achievement of "Stone Free" level for various size's stones does not exceed one day. Performing a SRULL of proximal ureter's large stones on the first day of a patient's hospitalization is accompanied by greater treatment efficacy. It statistically reliably determines the reduction in the frequency of postoperative complications.