Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

Fam, Xeng Inn; Singam, Praveen; Ho, Christopher C.K.; Sridharan, R.; Hod, Rozita; Bahadzor, Badrulhisham; Goh, Eng Hong; Tan, Guan Hee; Zainuddin, Zulkifli Md

doi:10.4111/kju.2015.56.1.63

Cited by 65 publications

(44 citation statements)

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“…A known complication after the treatment of impacted stones is the formation of ureteral strictures. In literature, stricture rates vary from 8 to 24% [ 14 , 24 – 27 ]. We assume that the reported short-term stricture rate in this study firmly underestimates the long-term stricture rate.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

et al. 2017

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PurposeTo describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.MethodsThe Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.ResultsOf the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.ConclusionsUreteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.Electronic supplementary materialThe online version of this article (doi:10.1007/s00345-017-2028-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

et al. 2017

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“…5 US is reported to occur in 1-4% of patients after ordinary URSL; however, it occurs in 7.8-24% of patients when URSL is performed for impacted stones. 6,7,8 Moreover, there are non-iatrogenic ureteric strictures such as those associated with impacted stones or chronic in ammatory disorders. 9,10 The main purpose of the management of US is to improve hydronephrosis and protect renal function.…”

Section: Introductionmentioning

confidence: 99%

Failure of endoscopic management of ureteral strictures is due to ureteroscopic lithotripsy as a cause and longer length of stricture

Taguchi

Hamamoto

Okada

et al. 2020

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Background Ureteroscopic lithotripsy is a common treatment for middle and lower ureteral stones. Although effective and minimally invasive, this technique might cause significant complications, including postoperative ureteral strictures, which occur in 1–4% of patients after ordinary ureteroscopic lithotripsy and in 7.8–24% when lithotripsy is performed for impacted stones. The main purpose of the management of ureteral strictures is to improve hydronephrosis and protect renal function. However, factors that influence the success rate of the endoscopic management of US (e.g., the cause and length of stricture, the duration of hydronephrosis, surgical management technique, and the number of placed ureteral stents) are controversial. The aim of this study was to investigate factors determining the outcomes of endoscopic management for stone-related ureteral stricture. Methods This multi-center case series study was performed at one of the highest-volume centers and the affiliated institutions in Japan. Data of patients who underwent endoscopic surgery for ureteral stricture from January 2016 to March 2019 were retrospectively analyzed. Laser incision and/or balloon dilation were performed for management; single or double stents were placed at the end of the surgery. Treatment success was defined as improvement in hydronephrosis status. Results Nineteen patients were treated for stone-related ureteral stricture. Hydronephrosis successfully improved in 12 patients (63.2%). All seven patients with failed endoscopic management had ureteroscopic lithotripsy-related stricture, whereas 3/12 (25.0%) and 7/12 (58.3%) patients with ureteroscopic lithotripsy-related stricture and impacted stone-related stricture, respectively, underwent successful endoscopic treatment (P = 0.004). Stricture length > 15 mm was observed in five patients (71.4%) with failed management, two patients (16.6%) with successful management (P = 0.046), 7/10 patients (70.0%) with ureteroscopic lithotripsy-related stricture, and 1/7 patients (14.3%) with impacted stone-related stricture (P = 0.049). Among patients with ureteroscopic lithotripsy-related stricture and impacted stone-related stricture, both laser incision and balloon dilation were performed in 5/10 (50.0%) and 2/7 (28.6%) patients (P = 0.874) while double stents were placed in 5/10 (50.0%) and 5/7 (57.1%) patients (P = 0.874), respectively. Conclusions Ureteroscopic lithotripsy as a cause and stricture length > 15 mm could strongly affect the success rate of endoscopic management of ureteral stricture. In such cases, reconstructive management should be considered in the early stages.

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“…Postoperative hydronephrosis may be caused by fibrinous exudates produced by the mucosa that precipitate, or fragments of calculi remaining in the ureteral mucosa, causing inflammation and ischemia [ 3 ]. It is reported that the incidence of ureteral stricture formation, as a late complication after URS, occurs in 0% to 4% [ 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

et al. 2016

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PurposeThis study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi.Materials and MethodsFrom January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis.ResultsA total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis.ConclusionsLarge preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.

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Ureteral stricture formation after ureteroscope treatment of impacted calculi: A prospective study

Cited by 65 publications

References 11 publications

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones

Failure of endoscopic management of ureteral strictures is due to ureteroscopic lithotripsy as a cause and longer length of stricture

Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

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