Impacted Ureteral Calculi Research Articles

Ureteroscopic pneumatic lithotripsy of impacted ureteral calculi

This work evaluates the results of ureteroscopic treatment of impacted ureteral stones with a pneumatic lithotripter. From March 1997 to May 2002, 42 patients with impacted ureteral stones were treated by retrograde ureteroscopic pneumatic lithotripsy. Twenty-eight patients were female and 14 were male. The stone size ranged from 5 to 20 mm. The ureteral sites of the stones were distal in 21, middle in 12 and proximal in 9. Considering stones with distal location in the ureter, 1 patient had ureteral perforation and developed a stricture in the follow-up (4.7%). As for stones in the middle ureter, 2 perforations and 1 stricture were observed (8.3%) and regarding stones located in the proximal ureter, 5 perforations and 4 strictures occurred (44%). In the mid ureter, 1 ureteral avulsion was verified. In 34 patients without ureteral perforation, only 1 developed a stricture (2.9%). Of 8 patients who had perforation, 6 developed strictures. The overall incidence of stricture following treatment of impacted ureteral calculi was 14.2%. Ureteroscopy for impacted ureteral calculi is associated with a higher incidence of ureteral perforation and stricture. Ureteroscopy of proximal ureteral calculi is associated with a high risk of perforation, when compared to mid or distal ureteral calculi. Ureteral perforation at the site of the stone seems to be the primary risk factor for stricture formation in these cases.

Antegrade flexible ureteroscopy in supine position for impacted multiple ureteric calculi

Flexible retrograde ureteroscope is now being widely used in endoscopic management of the urinary calculi. We report technique of supine ante grade flexible ureteroscopy in treating impacted upper and mid ureteric calculi in a pediatric patient. A six year-old boy with a history of acute right ureteric colic was investigated and found to have right upper and middle impacted ureteric calculi. He was planned for ureteroscopy, but the intramural part of the ureter could not be dilated. Hence, a decision was taken to do an antegrade flexible ureteroscopy in the supine position. An antegrade renal access was established in the supine position using ultrasound- guided puncture, a 22 Fr Amplatz was placed after serial dilatation of the tract and the stones were accessed using a flexible ureteroscope. The stones were then disintegrated using holmium laser. The ureter was stented at the end of the procedure. IVU done after six months revealed normal right kidney.

Bilateral urinoma due to an unilateral impacted ureteral calculus

A unilateral impacted lower ureteric calculus presenting as bilateral urinoma is rare, and spontaneous rupture of the ureter being the cause is even rarer. It is important to distinguish this uncommon condition from the much commoner condition of urinary extravasation from forniceal rupture. We are reporting a case of left lower ureteric calculus causing spontaneous rupture at the upper ureter presenting as bilateral retroperitoneal urinoma.

Does failure to visualize the ureter distal to an impacted calculus constitute an impediment to successful lithotripsy?

A severe degree of ureteral obstruction is viewed as a predictor of poor outcome in shockwave lithotripsy (SWL). Impacted stones are often considered a contraindication to in-situ SWL. Impaction in our study was defined as failure to visualize the ureter distal to the calculus with proximal hold-up of contrast for as long as 3 hours on an intravenous urogram (IVU). We evaluated 30 patients with impacted ureteral calculi, who were compared with a second unimpacted group matched for stone size and stone location. The calculi were reorganized into < or =10-mm and >10-mm groups. The results were compared in terms of clearance rates, number of shockwaves, number of sessions, and number of days between the start of SWL and clearance. Between January 1998 and December 2001, 30 impacted stones were treated with lithotripsy. Complete clearance rates in the impacted as well as the non-impacted group were 76.7%. There was no statistical difference in the number of shockwaves, sessions, or time to clearance. The results were poorer in lower-ureteral than upper-ureteral calculi, but this difference did not reach statistical significance. However, the differences between the < or =10-mm and >10-mm stones were statistically significant. Impaction on an IVU does not affect the results of lithotripsy.

New technique of ureteral stent placement for impacted ureteral calculus: the glidewire loop technique

Impacted ureteral stones pose a challenge during retrograde ureteral stenting. Multiple attempts to bypass the obstruction with conventional guide wires often fail and may result in perforation of the ureter. We describe a new, simple approach to overcome this common problem by utilizing a retrograde glidewire loop technique. The technique described allows safe and successful bypassing and stenting of ureteral obstruction.

Laparoscopic ureterolithotomy: the results of an initial series, and an evaluation of its role in the management of ureteric calculi.

To evaluate the place of laparoscopic ureterolithotomy in the management of ureteric calculi for which extracorporeal shockwave lithotripsy (ESWL) and endourological techniques are unsuitable. Laparoscopic ureterolithotomy was attempted in nine patients (eight men, one woman) with an age range of 26-81 years (mean 55.5) who had large, long standing and impacted calculi in the upper and mid ureter. The stone size ranged from 5 to 28 mm (mean 13.2) and stone duration ranged from one to 24 months (mean 8.2). The transperitoneal route was used in six patients and the extraperitoneal route in three but was converted to a transperitoneal approach in two. The stone was successfully removed in all nine patients. The operative time ranged from 80 to 260 minutes (mean 158). No intra-operative complication was encountered and no patient required a blood transfusion. Post-operative complications included urinary leak and fever. The post-operative stay ranged from 2 to 13 days (mean 5.2). Laparoscopic ureterolithotomy has definite advantages over open ureterolithotomy. Furthermore, the more difficult a stone is for treatment by ESWL and endourological techniques, the more suitable it is for laparoscopic removal. For large, hard, long-standing and impacted ureteric calculi, one laparoscopic ureterolithotomy as initial therapy may be preferable to multiple endourological and ESWL procedures.

Laparoscopic ureterolithotomy for impacted lower ureteral calculi: Initial case report

A laparoscopic ureterolithotomy was performed in a 63-year-old man who presented with azotaemia and large impacted calculi in the lower ureter. Although the procedure was performed transperitoneally, the ureter was completely re-peritonealized and drained extraperitoneally.

Ureteroscopic Removal of Ureteral Calculi in Bilateral Ureteral Duplications

Two rare cases of ureteroscopic removal of impacted ureteral calculi in patients with partial and complete ureteral duplication are described. The procedural steps and problems encountered are discussed. Successful ureteroscopic stone extraction was obtained in the 2 patients.

NEW FORCEPS FOR REMOVAL OF IMPACTED URETERAL CALCULUS

As a result of the improvements in urography made in the last few years, an increasingly large number of impacted ureteral calculi are being reported in the literature. It has been conservatively estimated that at least 90 per cent of all ureteral calculi may de demonstrated by careful roentgenography plus contrast pyelo-ureterography. In calculi that are deficient in lime salts and therefore possess poor shadow casting properties, a wax-bulb catheter may be used to corroborate the other observations. Approximately 75 per cent of ureteral stones become impacted in the lower segment of the ureter, and it is this location that is most difficult to reach surgically. While the mortality from ureterolithotomy is low, the morbidity is less conducive to operative intervention except in those cases in which the ureter is blocked and the patient is very toxic. Various nonoperative methods have been tried in removing these impacted