Is semirigid ureteroscopy sufficient in the treatment of proximal ureteral stones? When is combined therapy with flexible ureteroscopy needed? (original) (raw)
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Urology, 2005
Objectives. To compare the safety and cost-effectiveness of ureterorenoscopic holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy (URSL) with extracorporeal shock wave lithotripsy (ESWL) for proximal ureteral stones. Methods. This investigation assessed 220 patients with upper ureteral stones. Those in the ESWL group were treated on an outpatient basis using the Medispec Econolith 2000 (Medispec, Germantown, Md) under intravenous sedation. URSL was performed with a 6/7.5F semirigid tapered ureterorenoscope and holmium: YAG laser under spinal anesthesia on an inpatient basis. A successful outcome was defined as the patient being stone free on radiography 1 month after treatment. The stone size, success rate, postoperative complications, and cost were evaluated in each group. Results. A total of 220 patients were enrolled in this study. Hematuria and flank pain were the most common complaints in each group. The mean stone burden Ϯ SD was 58.7 Ϯ 3.1 mm 2 in the ESWL group and 108.4 Ϯ 10.0 mm 2 in the URSL group (P ϭ 0.000). The accessibility of the semirigid ureterorenoscope for upper ureteral stones was 98.1% (101 of 103), and the stone-free rate achieved after one treatment was 83.2% (84 of 101). The initial stone-free rate of in situ ESWL was 63.9% (76 of 119). Significantly, the initial stone-free rate of the URSL group was superior to that of the ESWL group (P ϭ 0.001). The average cost in the URSL group appeared to be lower than that in the ESWL group (P ϭ 0.000). Conclusions. The results of this study have demonstrated that URSL achieved excellent results for upper ureter calculi. In terms of cost and effectiveness, this procedure should be the first-line therapy for proximal ureter stones. UROLOGY 65: 1075-1079, 2005.
Urology journal
To investigate and compare the stone clearence and complication rates of flexible ureteroscopy (URS) with semirigid URS in patients having proximal ureteral stones. Materials and Methods: The data of 124 patients with proximal ureteral stones who underwent semirigid or flexible ureterorenoscopic lithotripsy between March 2008 and December 2012 were retrospectively investigated. The patients were divided into 2 groups according to the operation types. Group 1 included 63 patients who were treated with semirigid URS and group 2 was consisted from 61 patients who underwent flexible URS. Each group was compared in terms of stone diameter, successful access to the stone, operation time, reoperation rates, stone free status at postop-erative 1st and 3rd month and complications. Results: Successful access was achieved in 48/63 (76%) of the cases in group 1 and 57/61 (93%) of the patients in group 2 (P < .05). Initial stone free status was 63.4% (40/63) and 86.8% (53/61) in groups 1 and ...
Renal Ureteroscopy Treatment of Kidney and Bladder Stones
— The high incidence of urinary stones ranges from 20-40 years with a M / F ratio of 3: 1 The advent of extracorporeal shock wave lithotripsy associated with improved optical endoscopic have significantly reduced morbidity representing the gold standard for the treatment of urinary stones purpose of the study is to detect, by implementing an analysis of the physical and clinical parameters, the technique and complications of the procedure, the factors that can predict what the potential cases of high morbidity. Materials and methods From January 2000 to December 2014 were performed at the Surgical Clinic III of the University of Catania Policlnico 134 ureterorenoscopy procedures (URS) .the review covered the medical records considering the age, BMI, medical history, treatments and the stone free rate of URS the indication for therapeutic purposes has been carried out in the ureter and kidney stones of size handling <15mm, placement of ureteral catheter, ureteral stenosis, treatment of high urinary tract neoplasms. (Figure 9) .the procedure took an anesthesia care to spontaneous breathing, with cardiac monitoring. Discussion The development of complications in an investigation conducted is slightly higher than the detected case studies, (14%) in the absence of ureteral injury. the survey carried out has a therapeutic success in the first two years stood at 70% reaching the 90% at the end of the period observed, then the use of both general and spinal anesthesia promotes muscle paralysis avoiding potential injuries. With fast deployment anesthetics. Conclusion :The URS is a safe and reliable reality in the treatment of ureteral pathology. the analysis of clinical cases allows to state as the stretch pelvic ureter is easier to deal with both flexible semirigid uretroscopi that becomes essential when a complication arises stop take the appropriate therapeutic options in order to avoid the transformation into major complications.
Advances in Urology, 2015
Purpose. We aimed to compare and evaluate the outcomes and complications of two endoscopic treatment procedures, semirigid ureteroscopy (SR-URS) and flexible ureteroscopy (F-URS), in the treatment of proximal ureteral stones (PUS).Methods. SR-URS (group 1) was done on 68 patients whereas 64 patients underwent F-URS (group 2) for the treatment of PUS. Success rate was defined as the absence of stone fragments or presence of asymptomatic insignificant residual fragments < 2 mm. Outcomes and complications were recorded.Results. The differences were statistically not significant in age, gender, body mass index (BMI), and stone characteristics between groups. Mean ureteral stone size was 9.1 ± 0.4 mm and 8.9 ± 0.5 mm for groups 1 and 2. Mean operative time was 34.1 ± 1.5 min and 49.4 ± 2.3 min for groups 1 and 2 (p=0.001). SFRs were 76.5% and 87.5% for groups 1 and 2 (p=0.078). Two major complications (ureteral avulsion and ureteral rupture) occurred in group 1.Conclusion. F-URS is sa...
Central European Journal of Urology
10 years has been reported to be 26% in first-time stone formers [3]. The prevalence of urolithiasis in Western countries range from 8-19% in males and from 3-5% in females [4] and the prevalence of urolithiasis is increasing [5]. Studies suggest that ureteroscopy (URS) is as effective as extracorporeal shockwave lithotripsy (ESWL) for treating stones also in proximal parts of the urinary tract [6, 7]. The guidelines of the European Association of Urology (EAU) [8] recommend using
European Urology, 2014
Background: Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones. Objective: To describe the differences in the treatment and outcomes of ureteroscopic stones in different locations. Design, setting, and participants: Prospective 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. Intervention: Ureteroscopy was performed according to study protocol and local clinical practice guidelines. Outcome measurements and statistical analysis: Stone 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 limitations: Between 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 shortterm follow-up and a nonuniform treatment approach. Conclusions: Ureteroscopy for ureteral stones resulted in good stone-free rates with low morbidity. Patient summary: This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.
Journal of Endourology, 2010
Background and Purpose: Percutaneous nephrostolithotomy (PCNL) is the current standard of care for management of large renal stones (>2 cm). Recent studies have evaluated flexible ureterorenoscopy (URS)=holmium laser lithotripsy as an alternative treatment for patients with contraindications to or preference against PCNL. Stones in an intermediate size range (2-3 cm) may be most amenable to URS=laser lithotripsy as definitive treatment in a single stage. We report a multi-institutional series of URS=laser lithotripsy for renal stone burdens that measure 2 to 3 cm. Patients and Methods: Patients who underwent URS=holmium laser lithotripsy for renal stones that measured 2 to 3 cm were identified retrospectively at three tertiary care centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients with renal stone burdens of 2 to 3 cm who were treated by URS=laser lithotripsy and had at least one postoperative visit and imaging study were included. Stone clearance was evaluated using 0-2 mm and < 4 mm residual stone burden on postoperative imaging. Results: One hundred and twenty patients underwent URS=holmium laser lithotripsy for renal stones of 2 to 3 cm. Mean stone burden was 2.4 cm, and mean body mass index was 29.3 kg=m 2 . Indications for URS=laser lithotripsy vs PCNL included patient preference (57), technical or anatomic factors (24), patient comorbidities (17), failed shockwave lithotripsy (9), patient body habitus (3), solitary kidney (3), chronic renal insufficiency (3), and strict anticoagulation (2). Thirty-one (26%) patients had stent placement preprocedure, and 94 (78%) patients underwent outpatient surgery. A ureteral access sheath was used in 67%. One hundred and one (84%) patients underwent single-stage procedures. There was one intraoperative complication (ureteral perforation), and there were eight minor postoperative complications (6.7%). The reoperation rate through the mean 18-month followup was 3=120 or 2.5%. Seventy-six (63%) patients had residual stone burden of 0 to 2 mm, and 100 (83%) patients had residual burden of <4 mm. Conclusions: We demonstrate that single-stage URS=holmium laser lithotripsy is effective for management of renal stones that measure 2 to 3 cm through intermediate follow-up. Staged procedures can be used selectively for technical reasons or disease factors. Although PCNL achieves superior stone clearance overall, URS=laser lithotripsy is a viable treatment option for selected patients.
Journal of Endourology, 2009
Objectives: To study the outcome and safety of semirigid ureteroscopy (URS) using pneumatic lithotripsy for treatment of ureteral stones of surface area >30 mm 2 and to assess the impact of size and location on stone-free (SF) rate. Patients and Methods: In this study, 265 patients with >30 mm 2 isolated ureteral stones treated by semirigid URS were included. URS was performed using an 8F, 7F, or 6.4F semirigid ureteroscopes with pneumatic lithotripsy (Swiss LithoclastÔ). Stones were fragmented to *2-3 mm particles, and removed. The outcome parameters assessed at 3-month follow-up were SF rate and efficiency quotient (EQ); impact of stone size and site on SF=EQ was also analyzed. The patient demographics, stone, procedure, and patient-related parameters and complications were noted. Results: At 3-month follow-up overall SF was 74% and EQ 59.2%. SF for 30-100 mm 2 and >100 mm 2 was 79.2% and 68.5%, respectively ( p < 0.003). The SF=EQ for upper, middle, and lower ureteral stones were 59=40.7, 53=37.5, and 92=84.5, respectively ( p < 0.001). There was no major complication; the minor complication rate was 12.5%. Conclusions: Semirigid URS using pneumatic lithotripsy for treatment of stones >30 mm 2 is a safe and highly efficacious procedure particularly in the distal ureter. There is a significant difference in the SF and EQ between upper=middle ureteral stone and lower ureteral stone. Stone size has a direct relation with the SF and EQ. Upper ureteral stones have a longer time to SF compared to middle and lower ureteral stones ( p < 0.001). Abbreviations Used CT ¼ computed tomography EQ ¼ efficiency quotient IVU ¼ intravenous urogram KUB ¼ kidney, ureter, and bladder radiograph SF ¼ stone free SWL ¼ shock wave lithotripsy URS ¼ ureteroscopy US ¼ ultrasound v ¼ versus 622 ATHER ET AL.
Archivio Italiano di Urologia e Andrologia
Objective: We aimed to retrospectively evaluate the effectiveness and safety of flexible ureteroscopy (f-URS), semirigid ureteroscopy (sr-URS), and shock wave lithotripsy (SWL) to treat single 11-20 mm stones in the proximal ureter. Materials and methods: Patients treated at our clinic for 11-20 mm single stones in the proximal ureter who underwent f-URS, sr-URS or SWL as initial lithotripsy methods were compared in terms of their clinical characteristics and treatment outcomes. Results: A comparison among 201 patients who had undergone f-URS, 119 patients who had undergone sr-URS, and 162 patients who had undergone SWL showed no significant baseline differences in patients’ demographic and stone characteristics. Stone-free rates on the 15th day and 3rd month were higher with f-URS (89.6% and 97%, respectively) than with sr-URS (67.2% and 94.1%, respectively) and SWL (41.4% and 79.0%, respectively; all p < 0.001). Retreatment rates were significantly higher with SWL than with the...