Treatment Of Impacted Ureteral Stones Research Articles

Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review.

The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions.

Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.

Efficacy of semirigid ureterorenoscopy with the use of ureteral acsess sheath in the treatment of impacted ureteral stones: A prospective randomized study

Aim: To investigate the advantages of using Ureteral Access Sheat (UAS) with semirigid ureterorenoscopy in patients with impacted ureteral stones. Materials and Methods: One hundred and 22 adult patients that presented to our clinic with the complaint of impacted stones in the middle and upper parts of the ureter and were scheduled for surgical treatment. The procedure was performed without UAS in control group and using UAS in study group. Results: No significant difference was found between the two groups in terms of age, gender, stone disease history, presentation complaint, stone side, size, density and localization, degree of renal hydronephrosis, complications and length of hospital stay. Stone migration, operation time, duration of fluoroscopy, and postoperative additional surgical intervention rates were significantly lower in the UAS group [26.2% (n = 16) vs 11.5% (n = 7), p = 0.037; 35.46 ± 5.3 min vs 25.56 ± 4.2 min, p < 0.001, 5.50 ± 0.86 sec vs 3.24 ± 0.69 sec, p < 0.001; and 19.7% (n = 12) vs 6.6% (n = 4), p = 0.032, respectively]. The operation was successful in 48 (78.7%) patients in the control group and 57 (93.4%) in the UAS group, with a statistically significant difference (p = 0.019). Conclusion: The use of UAS in the treatment of middle-upper impacted ureteral stones presents as an advantageous method due to the shorter operation time and lower rates of intraoperative stone migration and high success rates of the operation.

The effect of using ureteral access sheath for treatment of impacted ureteral stones at mid-upper part with flexible ureterorenoscopy: a randomized prospective study.

The number of the studies made on the efficacy of flexible ureteroscopy (FURS) with ureteral access sheath (UAS) for impacted ureteral stones is limited. The aim of our study was to compare the efficacy and reliability of FURS in treatment of mid-upper impacted ureteral stones in cases where access is used or not. Between January 2017 and June 2018, 131 adult patients who applied to our clinic with complaints of mid-upper impacted ureteral stones. Patients were randomized as group 1 (without UAS) and group 2 (with UAS) by means of a draw and assessed in terms of demographic features, stone size, stone localization, hydronephrosis grade, operation time, scope time, the need for additional surgery, hospitalization time and complications. The mean age of the patients in group 1 was 45.01 years (19-76) and was 37.01 years (16-80) in group 2. Mean stone size was 9.04 mm2 and 9.77 mm2 in group 1 and 2, respectively. Additional treatment was required for 26 (42.6%) patients in group 1 and 8 (11.4%) in group 2. No major intraoperative and postoperative complications developed in both groups. Although bleeding as a postoperative complication rate was similar, fever (>38° C) and urinary tract infection were higher in group 1 than in group 2. In the treatment of mid-upper impacted ureteral stones, using UAS during the application of FURS is an advantageous procedure due to shorter operation time, fever intraoperative stone migrations and the need for additional surgery, less postoperative infection.

89 - Comparative study between laparoscopic and open ureterolithotomy and ureteroscopic lithotripsy for treatment of impacted ureteral stones > 15 mm

89 - Comparative study between laparoscopic and open ureterolithotomy and ureteroscopic lithotripsy for treatment of impacted ureteral stones > 15 mm

Holmium laser lithotripsy with semi-rigid ureteroscopy: a first-choice treatment for impacted ureteral stones in children?

BackgroundWe aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children.Material/MethodsWe evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification.ResultThe mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55).ConclusionsFor the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.

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.

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

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.

Results of Percutaneous Endoscopic Ureterolithotomy Compared to that of Ureteroscopy

Percutaneous endoscopic ureterolithotomy is not a well-known method for the treatment of impacted ureteral stones. The authors performed a retrospective study to compare the effectiveness of this procedure to ureteroscopy for the treatment of ureteral calculi. Impacted ureteral stones were removed in 93 patients by percutaneous endoscopic ureterolithotomy (Group 1). In 142 patients, ureteroscopy was performed for the treatment of the ureteral stones (Group 2). The same instruments were used to carry out percutaneous endoscopic ureterolithotomy as were used for percutaneous nephrolithotomy. During these interventions, a direct percutaneous puncture and extraction of the stones was performed. The average diameter of the stones was 11 +/- 4 mm in Group 1 and 7 +/- 2 mm in Group 2. The average operating time was 32 +/- 11 minutes in Group 1 and 41 +/- 29 minutes in Group 2. The average duration of hospitalization following the operations was 7.2 +/- 3.1 days in Group 1 and 3.5 +/- 2.5 days in Group 2. In Group 1, the average time of the operations was significantly lower (p 0.006), and the duration of postoperative hospital stay was significantly higher (p < 0.001), compared to Group 2. In Group 1, retroperitoneal hematoma occurred in 1 patient and prolonged urine leakage was detected in 2 cases, whereas in Group 2, pyelonephritis occurred in 5 patients following the operation. In conclusion, the operating time of percutaneous endoscopic ureterolithotomy is shorter and the rate of complications comparable with that of ureteroscopy. Percutaneous endoscopic ureterolithotomy is suggested for the removal of impacted ureteral stones instead of open surgical ureterolithotomy.

Ureteroscopic Holmium Lasertripsy for Treatment of Impacted Ureteral Calculi

Objective: To evaluate the effi cacy and safety of Holmium: YAG laser lithotripsy for the treatment of impacted ureteral stones. Patients and Methods: From January 2000 to January 2007, 150 patients (105 males and 45 females) with impacted ureteral stones were treated at the Urology Department of the Assiut University Hospital, Assiut, Egypt. Their mean age was 36 years (range 20 to 66 years). The mean duration of stone impaction was 4.6 months. The patients were managed via the retrograde endoscopic approach using small caliber (6.9 F rigid and 7.5 F fl exible) ureteroscopes and the Holmium:YAG laser lithotriptor. Results: Out of 150 ureteral stones, 144 (96%) were completely fragmented with a single endoscopic procedure. Proximal stone migration occurred in two cases, and the stones were treated by extracorporeal shock wave lithotripsy (ESWL). Intra-operative ureteral perforation occurred in 4 cases and was managed by open surgical treatment. Endoscopic observation revealed infl ammatory polyps at the site of impaction in 75 patients and a stricture adjacent to the stone in 20 cases. Conclusion: Holmium: YAG laser lithotripsy may be considered an effective fi rst-line therapy for chronically impacted ureteral stones, which are frequently associated with chronic infl ammation, polyps and strictures. It is quite safe and it avoids the futile repetition of ESWL and problems caused by a prolonged passage of stone fragments. Keywords : Ureteroscopy, holmium laser, impacted ureteral stone African Journal of Urology Vol. 13 (4) 2007: pp. 262-266

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.