Ureteral Stones Research Articles

Acute renal failure after kidney transplantation due to mizoribine-induced ureteral stones

IntroductionMizoribine (MZR) is used to prevent rejection reactions after kidney transplantation and increase the risk of hyperuricemia. There is a lack of reports of MZR-induced ureteral stones after kidney transplantation. The surgery treatment of ureteral stones in transplanted kidney is a challenging clinical issue that should only be performed by experienced urologists at professional centers. It is very important to have a thorough understanding of the patient's medical history, analyze the causes of stone formation, and choose a reasonable treatment plan based on the characteristics of the stones. The case report is aim to emphasize the recognition of the possibility of mizoribine-induced ureteral uric acid stones in transplanted kidney and to avoid unnecessary surgery.Case presentationA patient after kidney transplantation was diagnosed with acute renal failure caused by ureteral stones. The medical history, CT images of the renal graft, the results of laboratory test and stone composition analysis were provided. Based on medical history and laboratory test results, it was determined that the ureteral stones of renal graft was induced by MZR. To our best knowledge, this is the first report of MZR-induced stones in transplanted kidney and ureters. It was completely cured by urinary alkalinization, avoiding surgery treatment. We summarize the characteristics, treatment and methods for preventing the formation of uric acid stones of patients with MZR.ConclusionBy analyze our case report, it shows that acute renal failure with ureteral stones after kidney transplantation can caused by MZR. Urinary alkalinization for MZR induced uric acid stones is simple and effective.

Comparison of Outcomes of Extracorporeal Shockwave Lithotripsy with Ureteroscopic Lasertripsy for Management of Proximal Ureteral Stones.

To compare the outcomes of extracorporeal shockwave lithotripsy with ureterorenoscopy and lasertripsy for managing upper ureteral stones of size 10mm to 15mm. Observational, cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), from December 2020 to December 2021. A total of 168 patients with the diagnosis of proximal ureteric stone of size 1-1.5 cm were enrolled for this study. Patients were divided into two groups by simple random method. Group 1 patients underwent ureteroscopic lithotripsy (URS) and lasertripsy while Group 2 patients were subjected to extracorporeal shockwave lithotripsy (ESWL). Patients' demography, operative time, duration of hospitalisation, complication rate and stone-free rates, were recorded for both groups. Frequency and percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. For comparison of continuous variables, one-way ANOVA was applied, and Chi-square test was applied to compare the categorical variables. The p-value ≤0.05 was taken as significant. The mean age was of 39.55 ± 14.06 years, with the majority falling within the age group of 26 to 40 years. There were more males (116, 69%) than females (52, 31%). Most of the patients did not have a history of diabetes or hypertension. Sixty-two patients had previous history of stones. The average duration of ureteric stone disease was 3.18 ± 3.14 months. The mean size of the ureteric stone was 10.82 ± 3.19mm. The procedure duration was significantly shorter for URS, as compared to ESWL (33.81 ± 15.42 minutes vs. 45.00 ± 0.00 minutes, p=<0.01. The overall stone clearance rate was significantly higher after URS (83.3%) as compared to ESWL (64.2%, p=0.05). URS was a superior treatment option as compared to ESWL. However, the selection of the most appropriate procedure should be based on a tailored approach considering the patient's preference and the size of the stones. Extracorporeal shockwave lithotripsy (ESWL), Ureteroscopic lithotripsy (URS), Modified clavien classification system (MCCS), Ureteric stone.

A New Nomogram to Predict the Success of Shock Wave Lithotripsy in Ureteral Stones

Purpose. To design a new nomogram predicting the probability of stone‐free status of shock wave lithotripsy (SWL) in patients with ureteral stones. Materials and Methods. We retrospectively enrolled 2,144 patients with ureteral stones who underwent SWL between January 1993 and April 2020. The demographic and clinical parameters were assessed. The predictors of stone‐free status following SWL were identified. A logistic regression‐based nomogram was created by including the significant predictors in the multivariate analysis. Results. The mean age was 42.93 ± 13.85 in the stone‐free group (Group 1) and 46.51 ± 13.66 in the treatment‐failure group (Group 2) (p = 0.001). The cutoff value of the age was 45.5 years. The mean stone load was 0.71 ± 0.36 cm2 in Group 1 and 0.96 ± 0.51 cm2 in Group 2 (p = 0.001). Of the 2,144 patients, 1,708 (79.6%) were stone‐free within the first three SWL sessions. According to the multiple logistic regression analysis, older age, a stone load larger than 1 cm2, the presence of multiple stones, third‐generation lithotripter use, and pre‐SWL catheterization were statistically associated with low stone‐free rates. The C‐index was determined to be 0.75 in the bootstrapping method. Conclusion. A stone load larger than 1 cm2, age older than 45.5 years, the presence of multiple stones, new‐ (third‐) generation lithotripter use, and pre‐SWL catheterization had statistically significant effects on lower stone‐free rates in patients who underwent SWL due to ureteral stones. A nomogram was developed to predict the success of SWL. As a result of the internal validation of the nomogram, it was concluded to be suitable for clinical use.

Effect of the Hounsfield Unit Calculated on the Non-contrast Computed Tomography of Kidney and Ureteral Stones on the Success of Fragmentation with a Holmium: YAG Laser in Ureterorenoscopy and Retrograde Intrarenal Surgery

Effect of the Hounsfield Unit Calculated on the Non-contrast Computed Tomography of Kidney and Ureteral Stones on the Success of Fragmentation with a Holmium: YAG Laser in Ureterorenoscopy and Retrograde Intrarenal Surgery

Indications for Intervention in Patients Undergoing Ureteroscopic Therapy for Ureteric Calculus: A Cross-sectional Study

Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore , Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of &lt;0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (≥10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks

Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review.

We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP). A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted. Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients. SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.

A method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis.

To develop and validate a method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis. All 222 cases of ureteral stent data were obtained from the Fifth Affiliated Hospital of Sun Yat-sen University. Firstly, a neural network was used to detect the region of the ureteral stent, and the results of the coarse detection were completed and connected domain filtered based on the continuity of the ureteral stent in 3D space to obtain a 3D segmentation result. Secondly, the segmentation results were analyzed and detected based on the 3D morphology, and the centerline was obtained through thinning the 3D image, fitting and deriving the ureteral stent, and obtaining radial sections. Finally, the abnormal areas of the radial section were detected through polar coordinate transformation to detect the encrustation area of the ureteral stent. For the detection of ureteral stent encrustations in the ureter, the algorithm's confusion matrix achieved an accuracy of 79.6% in the validation of residual stones/ureteral stent encrustations at 186 locations. Ultimately, the algorithm was validated in 222 cases, achieving a ureteral stent segmentation accuracy of 94.4% and a positive and negative judgment accuracy of 87.3%. The average detection time per case was 12s. The proposed medical CT image ureteral stent wall stone detection method based on Mask-RCNN and 3D morphological analysis can effectively assist clinical doctors in diagnosing ureteral stent encrustations.

Efficacy and safety of in situ percutaneous neprolithotomy in upper ureteric impacted stones

Efficacy and safety of in situ percutaneous neprolithotomy in upper ureteric impacted stones

The effect of distal ureteral lateralization angle on ureteral trauma avoidance and successful ureteral access sheath placement.

The use of ureteral access sheaths (UAS), which offer advantages in flexible ureteroscopic lithotripsy (fURL), may lead to undesirable conditions such as ureteral injury, ischemia, and prolonged ureteral stenosis. The aim of this study was to investigate the effect of the distal ureteral lateralization angle on successful UAS placement. We analyzed the data of patients who underwent fURL for kidney and/or proximal ureteral stones retrospectively. Based on the preoperative computed tomographic examinations of the patients, the bladder outlet was considered the zero point. We calculated the angle values between the horizontal axis passing through this point and the most lateralized point of the distal ureter. The patients were divided into two groups: those to whom UAS was successfully placed and those to whom UAS placement failed. No significant difference was detected between the groups with successful UAS placement (n=36) and those without UAS placement (n=12) in terms of sex, laterality, localization, number of stones, stone burden, and bladder volumes evaluated with preoperative computed tomography (p>0.05). However, a significant difference was found between the two groups regarding age and distal ureteral lateralization angle (p<0.001, p=0.013). The distal ureteral lateralization angle is considered to be an effective factor in the placement of UAS in patients scheduled for fURS.

Renal Phaeohyphomycosis: Aureobasidium Pullulans Infection Caused by Instrument Inoculation in a Healthy Patient - A Case Report

Introduction: Aureobasidium pullulans, ablack yeast-like dematiaceous fungus. Most ofthese infections commonly affect the immunocompromised patients; however, post-instrument inoculation was extremely rare. This is the first report of renal phaeohyphomycosis by A. pullulans after stone surgeries reported worldwide, despite a thorough literature review. Case Report: A 29-year-old immunocompetent native lady, with underlying bilateral grade II renal parenchymal disease, was referred for right staghorn calculi and big left ureteric stone with bilateral hydronephrosis back in 2016. She underwent right percutaneous nephrolithotripsy (PCNL) and left ureteroscopic surgery (URS). Intra-operatively, 90% stone clearance for the right kidney and complete stone clearance was achieved over the left ureteric stone. Blood investigation showed Urea was 8.1 and Creatinine was 200 respectively. There was no growth in Urine C+S sent intraoperatively. Post-operatively, she did a DTPA scan which showed moderate impaired right kidney function (28ml/min-69%) with a non-functioning left kidney (13ml/min-13%). Her condition and renal function had been closely monitored during follow-up in the urology clinic. During follow-up, computed tomography urography (CTU) reassessment in 2018 showed residual right renal stones and resolved left hydronephrosis. Subsequently, she underwent right retrograde intrarenal surgery (RIRS) and ureteric stenting. Intraoperatively, complete stone clearance for the right upper and middle pole; there were a few blackish tubular foreign bodies seen at the right lower pole which were extracted and sent for investigations. Interestingly, the histopathology (HPE) reported as blood clots while the fungal PCR done by the Institute for Medical Research (IMR) showed Aureobasidium pullulans DNA detected. Post-operatively, she completed a one-month course of anti-fungal antibiotic and was discharged home well. Subsequent urine culture was cleared and CTU assessment showed no evidence of stone recurrence or foreign bodies. Discussion and Conclusion: Renal phaeohyphomycosis caused by Aureobadium pollulans secondary to post-instrument inoculation is first reported worldwide in an immunocompetent native lady.

Üreterorenoskopi sonrası double J stentin kadın cinsel fonksiyonlarına etkisi

OBJECTIVE: This study aims to evaluate the impact of double J stenting on female sexual functions following ureterorenoscopy (URS). MATERIAL and METHODS: Between April 2023 and September 2023, data from a total of 60 patients who underwent ureteroscopy (URS) treatment for ureteral stones in our clinic and a control group consisting of 30 individuals were retrospectively analyzed. Demographic and clinical characteristics of the patients, including age, body mass index (BMI), stone size, whether a double J stent was placed or not, length of hospital stay, duration of the double J stent in the patient, patients’ educational status, and Female Sexual Function Index (FSFI) scores at preoperative, postoperative 1 st, and 3rd months, were recorded. To assess psychological status, Beck Depression Scale scores were recorded at preoperative, postoperative 1 st, and 3rd months. The obtained parameters were compared between the groups. RESULTS: There were no statistically significant difference in mean age and BMI among the three groups (p=0.877 and p=0.932, respectively). The preoperative FSFI scores for Group 1, Group 2, and Group 3 were 13.83±1.76, 13.51±1.45, and 15.72±1.36, respectively. A statistically significant difference was observed among the groups (p&lt;0.001). The FSFI scores at postoperative 1st month were 14.2±1.39 for Group 1 and 12.82±1.5 for Group 2, with a statistically significant difference between the groups (p&lt;0.001). The FSFI scores at postoperative 3rd month were 14.54±1.7 for Group 1 and 14.4±1.54 for Group 2 (p=0.740). There was no statistically significant difference in Beck Depression scores during the preoperative period among the three groups (p=0.966). CONCLUSION: Based on our study, we believe that the placement of a double J stent after ureteroscopy (URS) may lead to a temporary impairment in female sexual functions. We recommend that patients be informed about this aspect during the preoperative period, suggest the removal of the double J stent at the earliest possible time when deemed necessary. Keywords: double J stent, female sexual function, ureteroscopy

Efficacy of DJ Stenting versus Silodosin after Ureteroscopic Lithotripsy for Lower Ureteric Stones: A Prospective Randomized Clinical Trial

Efficacy of DJ Stenting versus Silodosin after Ureteroscopic Lithotripsy for Lower Ureteric Stones: A Prospective Randomized Clinical Trial

Evaluation of safety and efficacy of different endoscopic modalities in management of large proximal ureteric stone: A prospective randomized study

Evaluation of safety and efficacy of different endoscopic modalities in management of large proximal ureteric stone: A prospective randomized study

Outcomes of ureteroscopy and laser fragmentation using a 60 W MOSES laser: a 3-year prospective study from a University Teaching Hospital.

Modulated optics enhancement system (MOSES) holmium lasers use "pulse modulation" to increase the efficacy of laser lithotripsy. As the clinical evidence on the efficacy of 60 W holmium laser with MOSES technology is scarce, we analyzed the outcomes of patients treated with this laser at our institution. A total of 96 consecutive patients with urinary stones (72 renal stones and 24 ureteral stones) were treated with the 60 W MOSES laser from 2019 until 2022 and were included in our analysis. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone-free rate, operating time, length of stay, and perioperative and postoperative complications. With a median age of 55 (IQR: 35-69.25) years, the male:female ratio was 53:43. The median stone size was 12 mm (IQR: 7-19), with a mean number of urinary stones of 1.82 (SD ± 1.4). While 36 (35%) patients were pre-stented, a ureteral access sheath was inserted in 36 (37.5%) patients. The median operative time was 44 min (IQR: 22.5-59.5), and 63 (65.5%) patients received postoperative stenting. Perioperative complications (all Clavien ⩽ II complications) were observed in 5 (5.2%) patients (four urinary tract infections and one acute urinary retention), and after the first procedure, 90 (93.8%) patients were stone-free. The median length of hospital stay was 1 day (IQR: 1-1). This study demonstrated that the 60 W MOSES laser was safe and efficient for the treatment of urinary stones with high stone-free rates and a small risk of minor complications. More studies with larger cohorts are necessary in the future to confirm our results.

Pooled-analysis of tadalafil and tamsulosin for ureteral calculi.

Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10mm in length. Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected. A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5mg or 10mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001]. Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10mm with a favorable safety profile.

Urologists' opinion on treating asymptomatic stones: Would we treat ourselves as we treat our patients? Survey from European Association of Urology, Young Academic Urologists, Endourology and Urolithiasis working party.

Management of asymptomatic kidney stones is an ongoing debate with follow-up and treatment guidelines based on low-level evidence. Our aim was to evaluate current management of asymptomatic urinary stones. A 70-question survey was designed in collaboration with European Association of Urology, Young Academic Urologists, Section of Uro-Technology and Section of Urolithiasis groups and distributed. Responders filled out hypothetical scenarios from 2 perspectives, either as treating physicians, or as patients themselves. A total of 212 (40.01%) responses were obtained. Median responder age was 39 years. 75% of responders were interested in "urolithiasis". 82.5% had never experienced a renal colic, 89.6% had never undergone urolithiasis treatment.Overall, as the kidney stone scenarios got more complicated, the invasiveness of the treatment preference increased. As "the physician", responders preferred the conservative option in all situations more than they would choose as "the patient". For ureteral stones, conservative approach was most preferred for small stones and ureteroscopy became more preferred as the stone size increased.For smaller kidney stones, the most preferred follow-up schedule was 4-6 monthly, whereas for larger and complicated stones it was 0-3 monthly from both perspectives respectively. For all ureteral stone scenarios, 0-4 weekly follow-up was mostly preferred.Interestingly, having had a renal colic was an independent predictor of an interventional approach, whereas having had an intervention was an independent predictor of a conservative approach. Current treatment and follow-up patterns of asymptomatic urinary stones are in agreement with international guidelines on symptomatic stones.In most of the urolithiasis situations urologists chose a conservative approach for their patients compared to what they would prefer for themselves. Conversely, urologists, in the scenarios as "the patient", would like to have a more frequent follow-up schedule for their stones compared to how they would follow-up their patients.

Renal Arteriovenous Fistulas during Pregnancy: Diagnosis and Treatment

A pregnant patient presented to the emergency-room with macrohematuria, and flank pain caused by a right lumbar ureter stone. Despite medical therapy, persistent macrohematuria and pain prompted the placement of a DJ stent and a catheter nephrostomy, but hemoglobin levels continued to decrease. Doppler ultrasound revealed a arteriovenous fistula. Following an initial conservative approach, the patient underwent fistula embolization, resulting in the successful closure of the fistula. The patient remained stable, and after 70 days, the baby was born. This case highlights the rare occurrence of arteriovenous fistula during pregnancy and the importance

Association of Severity and Type of Pain with Urolithiasis in Adults: A Computed Tomography Urographic Study

Background: Urolithiasis, a prevalent urological condition, especially in areas with warm and dry climates, poses significant healthcare challenges. In Pakistan, part of the "stone-forming belt," the incidence of urolithiasis is consistent with global prevalence rates. Understanding the demographic and clinical presentation patterns is essential for improving diagnostic and treatment strategies. Objective: The study aimed to determine the prevalence and characteristics of asymptomatic urolithiasis in adult patients and to evaluate the efficacy of multidetector computed tomography (MDCT) in detecting urinary tract stones and associated abnormalities. Methods: This cross-sectional study was conducted over four months at the University of Lahore Teaching Hospital's Radiology Department. A total of 112 adult patients aged between 18 to 70 years with symptoms indicative of urinary tract abnormalities were included using a convenience sampling technique. Siemens 64-slice MDCT was employed for diagnosis. The chi-square test and Fisher's Exact Test were utilized for statistical analysis to assess the association between urolithiasis and clinical symptoms, with p-values less than 0.05 considered significant. Results: Out of 112 patients, the prevalence of asymptomatic stones was 2.8%. Bladder stones were identified in 16 patients (14.3%) with a size range of 3-12 mm (mean 7.5 mm, S/D ratio 2.6). Ureteric stones were found in a subset of patients, with sizes ranging from 6-28 mm (mean 13.8 mm, S/D ratio 4.1). The prevalence of hydronephrosis was 39.9% for the left kidney, 26.1% for the right kidney, and 10.9% for bilateral presentation. Non-stone-related findings requiring treatment were identified in 14% of patients undergoing MDCT for renal colic. Conclusion: The study confirmed the prevalence of urolithiasis within the expected range for a high-risk geographic area. MDCT urography proved to be a valuable diagnostic tool in detecting not only urolithiasis but also other significant renal tract abnormalities. The results indicate a need for improved public health strategies, particularly for the at-risk older adult population.

Ureteric Laser Tripsy with and without Stone Cone

Stones may block the ureter causing pain and discomfort. Ureteric laser lithotripsy, a notable breakthrough in urology, has transformed the treatment of urinary tract stones. Objectives: To compare the efficacy of ureteroscopic laser lithotripsy with and without stone cone. Methods: This retrospective analysis was done at LRH Peshawar's urology department from 1st December 2022 to 31th October 2023. Over the time, 50 patients had ureteroscopic holmium laser lithotripsy. Our research comprised adults over 18 with proximal ureteric stones (&gt;10mm) and hydro ureters on CT KUB. Patients were split into two groups. Group A included 27 patients and employed a 7mm stone cone (Boston Scientific Corp, Natick, MA). No stone cone was utilized in group B (23). Results: This prospective research included 50 adults with radiologically confirmed uretric stones in diverse ureteric sites. Male 35 (70%) and female 15 (30%) were 21–68 years old (mean 38.6 years). Stones size varied from 6 to 20 mm, averaging 12.6mm. Proximal stones were 8–20mm (mean 13.9). Mid-ureter stones were 7–18mm (mean 12.6). Lower ureter stones ranged from 6 to 16mm, with a mean of 11.9mm. Ten (20%) patients have normal pelvicalyceal systems. Patients with moderate hydronephrosis were 27 (55%). Conclusions: The use of a stone cone during ureteroscopic lithotripsy is a safe and effective technique for the management of ureteric stones.

Analysis of the Efficacy of Flexible Ureteroscopy and Rigid Ureteroscopy with Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Stones in the Elderly

Objective: To compare the clinical efficacy of rigid ureteroscopy and flexible ureteroscopy with holmium laser lithotripsy in elderly patients with upper ureteral stones. Methods: 12 elderly cases of upper ureteral stones were selected and divided into two groups according to the type of surgery. The control group and the observation group adopted rigid ureteroscopic holmium laser lithotripsy and flexible ureteroscopic holmium laser lithotripsy, respectively. General observation indicators, laboratory indicators, and short-term efficacy-related indicators of surgery were compared between the two groups. Results: The operation time, ambulation time, and hospitalization time of the observation group were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P &lt; 0.05). There was no significant difference in the total primary/secondary stone clearance rate, postoperative complications, and disease recurrence rate after six months of follow-up in the two groups (P &gt; 0.05). Conclusion: Compared with rigid ureteroscopic holmium laser lithotripsy, flexible ureteroscopic holmium laser lithotripsy for elderly patients with upper ureteral stones is more conducive to shortening the treatment and postoperative recovery time, and simultaneously, it causes no severe complications and is worthy of promotion.