Outcomes of Ureteroscopy for the Management of Impacted Ureteral Calculi With Different Localizations

Abstract

To assess the effectiveness of Holmium:yttrium-aluminum-garnet lithotripsy for the treatment of impacted ureteral stones with different localizations. In this retrospective study, between January 2010 and October 2011, 105 patients underwent Ho:YAG laser lithotripsy for impacted ureteral stones with different localizations. Ninety patients (85.7%) had single ureteral stone and 15 (14.3%) had multiple stones. Single stone mean and multiple stone burden were 11.9 ± 4.6 mm and 23.8 ± 8.5 mm, respectively. Intraoperative and postoperative complications were grouped according to the modified Clavien grading system. Success rates with regard to stone localization after single endoscopic session for single stones were 95.7%, 88.8%, and 81.8% for lower, middle, and upper ureter, respectively. The stone clearance rate was reclassified as lower (below the iliac crest) and upper, the stone clearance rate was highest in the lower ureteral stones (55 of 57 patients, 96.5% vs 27 of 33 patients, 81.8%; P = .047). Operation time and the success rate were the only statistically significant parameters effecting the complications (P = .001 and P = .012). According to the Clavien classification system, the overall complication rate was 27.5% in our study. The distribution of 44 complications in 27 patients; grade I, II, IIIa, IIIb, and IVa was 17 (16.2%), 6 (5.7%), 7 (6.7%), 13 (12.4%), and 1 (0.9%), respectively. Complications are more common in patients with longer operation time and unsuccessful intervention. Ureterorenoscopy (URS) using Ho:YAG laser lithotripsy can be an effective and safely performed technique in impacted stones with different localizations and considered as the first-line approach at single setting.