Proximal Ureteral Stones Research Articles

A Prospective, Multi-Institutional Study of Flexible Ureteroscopy for Proximal Ureteral Stones Smaller than 2 cm

Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach. Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively. Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%. Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.

EFFECTIVITY OF PCNL WITH COMBINED ULTRASOUND AND FLUOROSCOPY

Objective: To assess the effectiveness of Percutaneous Nephrolithotomy (PCNL) at age > 65 years and its complication. Material & method: Fifty-four patients with renal and proximal ureteral stones who underwent PCNL with ultrasound techniques combined with X-Ray at Sardjito and Pantirapih hospital, during 2007 to 2012. Laboratory data is in the form of hemoglobin, leukocyte count, trombocyte, haematocrit, natrium, potassium, chloride, BUN, creatinine both pre-operative and post-operative. The samples were divided according to age < 65 years old and above. In analyzing categorical data, we used chi-square test, whereas the numeric data analysis is using independent t-test with p < 0.05. Results: We found no significant differences between the age groups < 65 years and age > 65 years in stone location, presence of hydronephrosis, its grade and location. There also no difference based on operative time, intra-operative procedure, its complication and the day of DJ stents removal and nephrostomy. Both group showed similar result on laboratory findings. However, we found that the older age group have 2 days longer in the length of hospitalization than the younger age groups (p = 0.05) and history of diabetes mellitus and hypertension with p < 0.05. Conclusion: PCNL is a safe and effective procedure with minimal complications for the treatment of kidney and proximal ureteral stone, even for patients with co-morbidity. PCNL technique with guidance of ultrasound for early access would help tomake the operating time shorter and less exposure to ionizing radiation.Keywords: Percutaneous nephrolithotomy, age > 65 years old, effectiveness, safety.

Low-cost semirigid ureteroscopy is effective for ureteral stones: experience of a single high volume center.

To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments. We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS) with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%), 86 in the mid (13.06%) and 368 (57.76%) in the distal ureter. In 504 patients (76.5%) ureterohydronephrosis (Grade II-III) was observed. In 57 patients (8.6%), we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1%) had more than one stone in their distal ureter and 96 (14.8%) had a proximal ureteral stone treated in the same surgery as well. The overall stone-free rate for ureteral stones was 86.1% (567/658). Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients), 84.8% (73/86 patients) and 96.4% (355/368 patients), respectively. One hundred and twenty patients (18.3%) required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74%) and URS plus Retrograde Intra-Renal Surgery (RIRS) in 23 patients (3.54%). The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%), erosions of urothelium leading to significant bleeding in 15 pts (2.27%), severe pain in 4 pts (0.6%), fever in 3 pts (0.45%) and one case of ureteral avulsion (0.15%). This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the procedure to an absolute minimum whilst maintaining the two quality indicators for the procedure, namely success rate and length of hospitalisation (86.1% and 34 hours).

1024 Impact of retrograde flexible ureteroscopy and intracorporeal lithotripsy on kidney functional outcomes

Editorial Comment: Ureteroscopy is now the most commonly performed stone removing procedure in North America and other regions of the world. Flexible ureteroscopy is commonly done in patients with proximal ureteral and renal stones. These instruments are fragile and costs for repairs/ replacements are high. The use of disposable ureteroscopes has been proposed for limiting costs. These investigators used a device composed of a single use multilumen catheter and a reusable optic fiber. Their outcomes for treating patients with proximal ureteral and renal stones were solid. However, they did not perform an economic analysis. The usefulness of disposable flexible endoscopes will need to be carefully assessed based on clinical as well as economic effectiveness.

V41 Single-stage laparoscopic management of impacted large proximal ureteric stone with concomitant multiple renal stones

V41 Single-stage laparoscopic management of impacted large proximal ureteric stone with concomitant multiple renal stones

Ureteroscopy: is it the best?

Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in '80s many technological improvements allowed to reduce endourological instruments' size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones <10 mm and >10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones <20 mm, and second choice for stones >20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.

PD36-04 RENAL PERCUTANEOUS ACCESS WITH THE URO DYNA-CT

You have accessJournal of UrologyStone Disease: New Technology I1 Apr 2014PD36-04 RENAL PERCUTANEOUS ACCESS WITH THE URO DYNA-CT Fabio Torricelli, Khaled Fareed, Gordon McLennan, Shubha De, and Manoj Monga Fabio TorricelliFabio Torricelli More articles by this author , Khaled FareedKhaled Fareed More articles by this author , Gordon McLennanGordon McLennan More articles by this author , Shubha DeShubha De More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2441AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolitothomy (PCNL) is the gold standard for surgical management of renal stones >2cm. Renal access may be challenging in cases of complex renal anatomy or large stone burden (i.e. complete staghorn calculi). Herein, we present percutaneous renal access using an Uro Dyna-CT (Siemens Healthcare Solutions, Germany), for high-quality 3-dimensional real-time imaging. METHODS Review of an index patient: 50y/o male presenting with a right partial staghorn and proximal ureteric stone. RESULTS Electing to undergo PCNL, he was referred to radiology for pre-op percutaneous renal access. Two attempts for upper/middle pole NT placement were made (to simultaneously treat lower pole and ureteric stones), however due to the plural reflection and overlying liver a safe puncture tract could not be established. A Uro Dyna-CT was performed by correlating real time fluoroscopic imaging to a simultaneous on-table axial CT scan (Figures 2-3). Delineating a safe window, right middle pole access allowed subsequent PCNL to be performed successfully. CONCLUSIONS In select patients, the Uro Dyna-CT adds simultaneous detailed anatomic imaging to fluoroscopic renal access to improve successful puncture, and reduce potential morbidities. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e902 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Fabio Torricelli More articles by this author Khaled Fareed More articles by this author Gordon McLennan More articles by this author Shubha De More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD37-12 PATIENTS PREFER THE USE OF A PATIENT DECISION-MAKING AID WHEN DISCUSSING SURGICAL OPTIONS FOR NEPHROLITHIASIS

You have accessJournal of UrologyStone Disease: New Technology II1 Apr 2014PD37-12 PATIENTS PREFER THE USE OF A PATIENT DECISION-MAKING AID WHEN DISCUSSING SURGICAL OPTIONS FOR NEPHROLITHIASIS Necole M. Streeper, Brian C. Sninsky, Kristina L. Penniston, Sara L. Best, and Stephen Y. Nakada Necole M. StreeperNecole M. Streeper More articles by this author , Brian C. SninskyBrian C. Sninsky More articles by this author , Kristina L. PennistonKristina L. Penniston More articles by this author , Sara L. BestSara L. Best More articles by this author , and Stephen Y. NakadaStephen Y. Nakada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2030AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients desire to have an active role in making their own healthcare decisions. The purpose of this study was to evaluate whether a patient decision-making aid (PDMA) would be useful for patients considering surgical treatment for nephrolithiasis. METHODS Patients with a history of nephrolithiasis were recruited from our stone clinics and were given a hypothetical case of an asymptomatic 10 mm proximal ureteral stone for which the urologist recommends elective surgical intervention. Shock wave lithotripsy (SWL) and ureteroscopy (URS) were presented as acceptable options in this scenario. A PDMA was developed to educate the patients about the two surgical options, comparing equivalent procedural variables and providing pictures of relevant urinary tract anatomy. Patients were presented with information about both surgical therapies by a urologist in a lecture format, both utilizing the PDMA and without the aid. We assessed patients’ satisfaction with each format and invited comments about the PDMA and its content, design, and clarity. RESULTS Participants (n=14; 4 male, 10 female) were 61.3±8.8 years of age. The majority of the participants found the PDMA helpful (85.7%), but identified areas for improvement. Specifically, patients wanted more information about the possibility of stent placement, details about stent discomfort, information about long-term effects for each surgical modality and financial comparison. There was a preference for utilization of a PDMA (78.6%) because it was felt to help them understand the treatment options more clearly with the visual aid compared to the session without the aid. Interestingly, 8 of 14 participants prefer to decide based on the surgeon’s recommendations but still reported a utility for the PDMA in this process. CONCLUSIONS PDMAs are increasingly used in medical and surgical management of several diseases and require patient input in their development. In our study, the use of a PDMA was preferred by patients and assists in making an informed decision with regard to surgical options for the management of stone disease. Of note, most of our patients still preferred to make decisions based on the surgeon's recommendation. Patients suggested the addition of specific information to the PDMA that may enhance its utility and applicability in the clinical setting. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e950 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Necole M. Streeper More articles by this author Brian C. Sninsky More articles by this author Kristina L. Penniston More articles by this author Sara L. Best More articles by this author Stephen Y. Nakada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of ESWL and Ureteroscopic Holmium Laser lithotripsy in Management of Ureteral Stones

BackgroundThere are many options for urologists to treat ureteral stones that range from 8 mm to 15 mm, including ESWL and ureteroscopic holmium laser lithotripsy. While both ESWL and ureteroscopy are effective and minimally invasive procedures, there is still controversy over which one is more suitable for ureteral stones.ObjectiveTo perform a retrospective study to compare the efficiency, safety and complications using ESWL vs. ureteroscopic holmium laser lithotripsy in management of ureteral stones.MethodsBetween October 2010 and October 2012, 160 patients who underwent ESWL or ureteroscopic holmium laser lithotripsy at Suzhou municipal hospital for a single radiopaque ureteral stone (the size 8–15 mm) were evaluated. All patients were followed up with ultrasonography for six months. Stone clearance rate, costs and complications were compared.ResultsSimilarity in stone clearance rate and treatment time between the two procedures; overall procedural time, analgesia requirement and total cost were significantly different. Renal colic and gross hematuria were more frequent with ESWL while voiding symptoms were more frequent with ureteroscopy. Both procedures used for ureteral stones ranging from 8 to 15 mm were safe and minimally invasive.ConclusionESWL remains first line therapy for proximal ureteral stones while ureteroscopic holmium laser lithotripsy costs more. To determining which one is preferable depends on not only stone characteristics but also patient acceptance and cost-effectiveness ratio.

Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

BackgroundUreteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones. ObjectiveTo describe the differences in the treatment and outcomes of ureteroscopic stones in different locations. Design, setting, and participantsProspective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period. InterventionUreteroscopy was performed according to study protocol and local clinical practice guidelines. Outcome measurements and statistical analysisStone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations. Results and limitationsBetween January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n=2656), midureter (n=1980), distal ureter (n=4479), or multiple locations (n=440); location in 126 patients was not specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8–7.7%). Postoperative complications occurred in 2.5–4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include short-term follow-up and a nonuniform treatment approach. ConclusionsUreteroscopy for ureteral stones resulted in good stone-free rates with low morbidity. Patient summaryThis study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.

Laparoscopic stone surgery with the aid of flexible nephroscopy.

PurposeTo report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy.Materials and MethodsA retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed.ResultsThe patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed.ConclusionsLaparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

A Comparison of Antegrade Percutaneous and Laparoscopic Approaches in the Treatment of Proximal Ureteral Stones

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

Treatment of pediatric promxial and middle ureteral stones: percutaneous nephrolithotomy versus retrograde ureteroscopic lithotrispy

Objective To compare the efficacy,safety,and morbidity of minimally invasive percutaneous nephrolithotomy under Doppler ultrasound guidance (MPCNL) and retrograde ureteroscopic lithotrispy (URSL) for upper and middle ureteral stones in children younger than 5 years.Methods Eightynine cases of children younger than 5 years from January 2008 to November 2011 were reviewed.There were 53 patients accepted MPCNL and 36 patients undergoing URSL.Patients who needed more than one percutaneous tract or had simultaneously undergone the two techniques on the same kidney or need more than one session surgery were excluded from the study.Results The two groups had comparable stone burden of (13.7±5.1) mm and (12.9±3.2) mm in MPCNL and URSL group respectively.The demographic data were similar as well.In MPCNL group,percutaneous-renal access was established and lithotripsy was preformed in one session,with the access time of (9.5±4.9) min and operative time of (35.8±7.6) min.The stone-free rate was 100.0％.The hemoglobin and hematocrit dropped by (6.72± 1.63) g/L and (2.34±0.57)％ respectively.The mean hospital stay after surgery was 8.5 d.The complication in MPCNL group was postoperative fever in 12 (22.6％) cases.No perioperative bleeding,renal lost or septic shock was recorded,and no transfusion was required.No perirenal organ injury was recorded.In URSL group,the operative time was (66.8 ± 28.5) min with the stone-free rate of 63.9％ in single session.The hemoglobin and hematocrit dropped by (4.42±1.52) g/L and (1.85±0.13)％ respectively.The mean hospital stay after surgery was 13.2 d.The complications of URSL group included postoperative fever in 19 (52.8％) cases,ureteral perforation in 7 cases.The mean follow-up duration was 24 months (range,16-38 months).Three (8.3％) ureteral stricture cases were recorded in URSL group postoperatively,which was not reported in MPCNL group.The MPCNL group was significant better than URSL group in terms of stone-free rate in one session,operative time and hospital stay (P＜0.05).Conclusion MPCNL could be safe and effective for managing proximal and middle ureteral stone in pediatric patients with significantly higher stone-free rate,shorter operative time and lower incidence of bleeding and less complications compared with URSL. Key words: Infant; Child, preschool ; Ureteral calculi ; Percutaneous nephrolithotomy ; Ureteroscopy

Efficacy of retroperitoneal laparoscopic ureterolithotomy for the treatment of large proximal ureteric stones and its impact on renal function

PurposeThe purpose of this study was to evaluate the efficacy of retroperitoneal laparoscopic ureterolithotomy for the management of large proximal ureteric stones and the impact of this treatment on postoperative renal function.MethodsThe data of 12 patients (7 men and 5 women; mean age, 68.5 ± 8.9 years) with large pyeloureteral junction (2 cases) and upper ureteral (10 cases) stones (25.3 ± 7.4 mm) that had undergone retroperitoneal laparoscopic ureterolithotomy were reviewed. Renal function was analyzed by the estimated glomerular filtration rate (eGFR) and renal scintigraphy using 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) before and 3 months after surgery.ResultsThe mean operative time was 129.5 ± 21.4 minutes, with a mean blood loss of 64.4 ± 78.2 mL. The mean duration of hospital stay after surgery was 6.4 ± 2.7 days, and the mean duration of stenting was 7.2 ± 1.7 weeks. A stone clearance rate of 100% was achieved, and no patient developed ureteric stricture. 99mTc-MAG3 scintigraphy showed that laparoscopic removal of calculi did not affect renal function, but did improve ureteral occlusion.ConclusionsRetroperitoneal laparoscopic ureterolithotomy is a safe and effective treatment option for reducing ureteral obstruction in select patients with large proximal ureteric stones.

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

Ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy

The aim of this study was to examine the feasibility of ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy and to evaluate the effects of retrograde ureteroscopic access exerted on the sutured ureterotomy site. From January 2002 to December 2011, 30 patients with proximal ureteral stone underwent ureteroscopic double-J stenting of the ureter following retroperitoneal laparoscopic ureterolithotomy. Patient demographics and perioperative parameters, including the degree of hydronephrosis, urine leakage, and drainage time, were retrospectively reviewed. These data were compared with those of 30 consecutive patients who received open ureterolithotomy and intracorporeal ureteral double-J stenting. In addition, a PubMed search was conducted and the related literature on the placement of a ureteral stent was reviewed. Twenty-eight patients successfully underwent ureteral double-J stenting with ureteroscopic access. No malposition of the ureteral stent was identified in the ureteroscopic group, but two patients in the intracorporeal group required postoperative adjustment of the stent. Residual stone fragments were found during stent placement in three patients in the ureteroscopic group and holmium:yttrium–aluminum–garnet laser lithotripsy was immediately performed. There was no significant difference in postoperative outcomes or complication rates between the two groups. Ureteroscope-assisted ureteral double-J stenting is a simple and safe alternative allowing intraluminal navigation along the entire ureter, correct stent placement, and prompt treatment of residual stone fragments, without radiation exposure. In addition, ureteral disruption and urinary extravasation may not be concerns for ureteroscopic access with continuous normal saline irrigation.

Comparison of minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy for proximal ureteral calculi

Objective To compare the safety and clinical efficiency between minimally invasive percutaneous nephrolithotomy(MPCNL)in supine position and flexible ureteroscopy(FURS)in management of proximal ureteral calculi.Methods From Oct.2010 to May.2012,76 patients with single proximal ureteral calculus between 10-20 mm failed in SWL or other conservative therapy accepted MPCNL (32 cases)or FURS(44 cases).There was no significant difference between the groups in base-line parameters.Stone sizes were(15.6±2.5)mm and(14.9±2.3)mm,P＞0.05.Procedural time,post-operative hospitalization stay,complication rates(Clavien degree Ⅱ or over)and stone free rates were compared.Results In these two groups,procedural time was(49.3± 11.7)and(67.2± 17.3)min,P＜0.05,postoperative hospitalization stay were(4.2±1.1)and(1.8±0.8)days,P＜0.05,complication rates were 12.5％ and 6.8％,P＞0.05 and stone free rates(residual fragments≤3 mm)were 93.7％ and 84.1％,P＞0.05.Conclusions For patients with surgically indicated proximal ureteral calculi,both minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy are effective and safe therapeutic modalities.Patients treated with flexible ureteroscopy have faster postoperative recovery. Key words: Proximal ureteral stone; Percutaneous nephrolithotomy; Supine position; Flexible ureteroscopy

Extracorporeal Shock Wave Lithotripsy (ESWL) vs. Ureterorenoscopic (URS) Manipulation in Proximal Ureteric Stone

To compare the stone free rate at one week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10 - 15 mm size). Randomized controlled trial. Sindh Institute of Urology and Transplantation (SIUT), Karachi, from August 2010 to February 2011. One hundred and ninety patients with 10 - 15 mm proximal urteric stone, in each group were treated with ESWL and ureterorenoscopic manipulation by using an 8.0 or 8.5 Fr semi rigid ureteroscope. Intracorporeal lithotripsy was performed by using pneumatic lithoclast. The stone free rate were compared between groups by considering size of stone at one week after procedure. The success rate, retreatment rate, auxiliary procedure and complication rate were compared in each group. Success rate was 49.2% for ESWL and 57.8% for URS (p = 0.008). The re-treatment rate was significantly higher in ESWL group than in URS group (40% vs. 11 and 18% in URS group). Although ESWL is regarded as the preferred choice of treatment for proximal ureteric stone, the present results suggest that ureterorenoscopic manipulation with intracorporeal lithotripsy is a safe alternative, with an advantage of obtaining an earlier or immediate stone-free status. Laparoscopic approaches are reasonable alternatives in cases, where ESWL and URS have failed.

S224 Two stage approach for the management of completely impacted proximal ureteric stones

S224 Two stage approach for the management of completely impacted proximal ureteric stones

Comparison of Ho:YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: An analysis of risk factors

The aim was to compare pneumatic and holmium:yttrium-aluminum-garnet laser in the treatment of impacted ureteral stones with different locations and to identify the risk factors for complications. Between March 2005 and November 2012, a total of 230 patients underwent ureteroscopic lithotripsy for impacted stones. Of the patients, 117 had pneumatic and 113 had laser lithotripsy for the fragmentation of the stones. Treatment outcomes based on evidence of being stone free were evaluated. Preoperative, operative, and postoperative follow-up findings were analyzed and compared. There was a difference between the two groups according to overall stone clearance rate (93.8% vs. 80.3%, p = 0.002). There was no statistically significant difference for distal location between the laser and pneumatic groups (96.8% vs. 91.7%, p =0.288). For 10 patients with intrarenally migrated stones who were managed with flexible ureterorenoscopy in the same session, laser lithotripsy was more successful than pneumatic for proximal ureteral stone (94.4% vs. 67.9%, p = 0.007). The overall complication rate was 26.1%. There was no statistically significant difference between the two groups (29% vs. 23%, p = 0.296). Multivariate logistic regression analysis revealed that the proximal location was a statistically significant parameter for the occurrence of complications in both groups (p = 0.001 for PL, p = 0.004 for laser). The pneumatic and holmium:yttrium-aluminum-garnet laser lithotripsy are effective in the treatment of distal impacted stones. Both treatments with semirigid ureteroscopy are acceptable for proximal impacted ureteral stones, but holmium laser lithotripsy has an advantage of use with flexible ureteroscope for intrarenally migrated stone.