Abstract
The goals of this study were to examine cases of proximal ureteral stones in which semirigid or flexible ureteroscopes alone were insufficient for endoscopic treatment, requiring the combination of both. A total of 137 patients were retrospectively evaluated. Holmium laser was used as the energy source for stone fragmentation. Each operation was begun with a 6/7.5 Fr semirigid ureteroscope (URS), and continued with a 7.5 Fr flexible URS in those procedures that failed to reach the stone or push-up. Double J stents were inserted into those patients in whom the flexible URS failed. Shock wave lithotripsy (SWL) or a repeat ureteroscopy (after 2–4 weeks) was planned in those patients who were considered to be treated unsuccessfully. The demographic features of the patients, stone sizes, treatment outcomes, need for additional treatment, complications, and the results of the postoperative 1-month early follow-up were evaluated. The mean age of the patients (77 males and 60 females) was 38 ± 6.7 years old, the mean stone size was 12.3 ± 3.7 mm, and the number of patients with persistent hydronephrosis was 86 (62.8 %). A stone-free diagnosis was achieved in a total of 124 patients (90.5 %), using a semirigid URS in 80 patients and a flexible URS in 44 patients. Treatment using a flexible URS was administered in 38 patients (27.7 %) due to push-up, and in 6 patients (4.3 %) because of the failure to advance the semirigid URS into the ureter. The treatment failed in 13 patients (9.4 %) despite the use of both methods. Treatment using low-caliber semirigid ureteroscopy and a holmium laser is possible, regardless of the stone size, in female patients without hydronephrosis. However, the need for combined treatment with flexible ureteroscopy is increased in male patients with hydronephrosis.
Highlights
There is no one single treatment method for proximal ureteric stones, but there are several different approaches
We examined cases in which both of these ureteroscopic tools failed in the endoscopic treatment of proximal ureteral stones, requiring combined use
A stone-free diagnosis was achieved in a total of 124 (90.5 %) patients using the semirigid URS in 80 patients, and flexible ureteroscopy in 44 patients
Summary
There is no one single treatment method for proximal ureteric stones, but there are several different approaches. Extracorporeal shockwave lithotripsy (SWL), ureteroscopy, percutaneous nephrolithotomy (PCNL), antegrade ureterolithotripsy, laparoscopy, and rarely, open surgical procedures are implemented (Wolf 2007). SWL and ureteroscopy are considered to be the primary methods for the initial treatment of Turkan et al SpringerPlus (2016) 5:30. Some cases have been encountered in which both tools fail. It is possible to use both tools in combination, with their complementarity increasing their success rates. We examined cases in which both of these ureteroscopic tools failed in the endoscopic treatment of proximal ureteral stones, requiring combined use. We evaluated the extent to which this combined approach can be complementary, and how this affects the results with regard to successful treatment
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