You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20121826 STUDY OF SILENT OBSTRUCTION AFTER URETEROSCOPIC MANAGEMENT OF IMPACTED URETERAL STONES Soichi Mugiya, Masao Nagata, Hiroshi Furuse, and Seiichiro Ozono Soichi MugiyaSoichi Mugiya Hamamatsu, Japan More articles by this author , Masao NagataMasao Nagata Hamamatsu, Japan More articles by this author , Hiroshi FuruseHiroshi Furuse Hamamatsu, Japan More articles by this author , and Seiichiro OzonoSeiichiro Ozono Hamamatsu, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1914AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Improved endoscope and advanced devices have significantly decreased the incidence of complications during ureteroscopy (URS). Despite recent reports suggesting that routine postoperative imaging may not be necessary in all individuals after URS silent obstruction may develop in some, ultimately resulting in renal damage. We evaluated the incidence and factors associated with postoperative abnormal imaging without symptoms after URS for impacted ureteral stones. METHODS We retrospectively reviewed the records of 377 patients who underwent URS for impacted ureteral stones at our institution. Our URS procedure using a small-caliber ureteroscope and a holmium: YAG laser has been reported previously (J. Urol. 171: 89, 2004). All of the patients routinely underwent IVP in order to assess for obstruction or delayed excretion at 1 month after URS. Abnormal imaging was defined when postoperative imaging did not show improvement of hydronephrosis. Patient characteristics as well as endoscopic findings were reviewed to identify factors associated with abnormal post-URS imaging. RESULTS Of the 377 patients 19 (5%) revealed abnormal postoperative imaging without symptoms. All 19 patients underwent secondary ureteroscopy in order to assess and alleviate obstruction. 19 patients with a mean age of 59 years were included. Mean diameter of the initial target stone was 14 mm (range 2-23) with stone location being 13 proximal, 5 distal, and one mid ureter. Mean duration of impaction was 31 months (range 2-84). Second URS revealed obstruction due to ureteral stricture in 16, complete ureteral occlusion in 2 and ureteral tortuosity in 1. Second URS detected a severe ureteral stricture related to laser therapy distal to the successfully treated stone. The obstruction eventually resolved with endoscopic balloon dilation in 17 out of 19 patients. 2 patients ultimately received ureteroureterostomy and 2 were lost to follow-up. Among these 19 patients, initial URS revealed inflammatory ureteral polyps associated with the calculi in 9 and ureteral stricture in 6. Stone location, stone size, operative time, duration of impaction and stone composition were not associated with abnormal post-URS imaging. CONCLUSIONS Our analysis suggests that silent obstruction remains a potentially significant complication after URS for long-term impacted ureteral stones which are frequently associated with ureteral polyps and strictures. Therefore, we recommend that routine postoperative imaging should be performed after URS to avoid the potential complications of unrecognized ureteral obstruction. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e737-e738 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Soichi Mugiya Hamamatsu, Japan More articles by this author Masao Nagata Hamamatsu, Japan More articles by this author Hiroshi Furuse Hamamatsu, Japan More articles by this author Seiichiro Ozono Hamamatsu, Japan More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...