Ureteropyeloscopic Removal of Ureteral Calculi

Abstract

Ureteroscopy has been used for the treatment of calculi throughout the ureter. The results of ureteroscopic stone removal were reviewed in 100 patients. Similar results were compared in 30 patients undergoing ureterolithotomy and 32 treated by basket manipulation. Success of ureteroscopic removal was related to the location of the calculus: 50 per cent in the proximal, 80 per cent in the mid and 99 per cent in the distal ureter. Hospital stay, costs and narcotic analgesic use were significantly less for ureteroscopic stone removal than for open surgical lithotomy. The success rate for ureteroscopic removal of distal calculi (99 per cent) was higher than for blind basketing procedures (59 per cent). Ureteroscopy should be considered the technique of choice for the removal of distal ureteral calculi. It is an acceptable alternative for treatment of calculi throughout the urinary tract.

ESWL of Stones in the Mid-Ureter

“…These techniques have been accompanied in up to 35% by minor complications like hematuria, fever, mild ureteral trauma and proximal stent migration, in addition major complications (8%) like ureteral perforation, avul sion, necrosis, stricture and ureteral-valve insufficiency after dilatation when rigid LISL is used are encountered [ 11 ]. Among the latter, ureteral perforation is the most common complication and has been reported to occur in up to 28% of all procedures [3,11], Furthermore, 3 or 4 h -in general anesthesia -are not unusual for successful fragmentation of a large impacted calculus [13], which does not mean stone clearance. Contrary to these programs, our complication rate using ESWL first is very low with no severe aftermaths and corresponds to similar studies [14][15][16][17][18], In addition, the amount of invasive measures has been lowered to 29.5%.…”

Endourological Treatment of Lumbar and Iliac Ureteral Stones

“…This situation requires different strategies adapted to the particular technological environment. The enor mous progress in the field of endourology now allows almost all urinary calculi to be treated with a minimal investment [5,6,19]. The lithotripsy techniques available for the treatment of ureteral stones range from laser tech niques to wire stone baskets and include electrohydraulic shock waves, ultrasound and the Lithoclast, which is the most recent model of endourological lithotriptor [20], Although laser is effective for ureteral stones, its major disadvantage is its high purchase and maintenance costs.…”

“…These results are comparable to those obtained by Schulze et al [20], Our success rate was partly due to the use of several technical devices. In order to prevent ascension of ureter al stones into the renal cavities, we use, like Seeger et al [6], the lowest possible irrigation pressure by placing the reservoir 60 cm above the patient. The irrigation flow rate is adjusted by the operator at the inlet tap of the ureteroscope.…”

“…The development of extracorporeal shock wave lithotripsy (ESWL) [1] and endourology (percutaneous renal surgery [2,3] and urete roscopy [4][5][6]) have lowered the ureterolithotomy rates to 1-5% of all treatments for ureteral stones [7,8], Although the first-line treatment for ureteral stones is drug therapy, this modality can only be applied to small stones (less than or equal to 4 mm in diameter) in well-informed and patient subjects with sterile urine. According to Morse and Resnick [9], the spontaneous passage rate of stones 1-4 mm in diameter of the lumbar, iliac and pelvic ureter varies between 93 and 20%.…”

A Retrospective Evaluation of 691 Ureteroscopies: Indications, Procedures, Success Rate and Complications

“…No figures showing the exact progress obtained with ureteroscopy compared to former practice have been presented, and the results have been evaluated retrospectively. No doubt, ureteroscopic stone removal is superior to blind basket manipulation of distal ureteral stones [9], However, the comparison of results is difficult. We wanted to include all aspects and, therefore, classified the results considering the technical part, evalu ating both if the ureteroscope could be introduced to a suspected pathology and the completion of each separate ureteroscopical procedure, and the overall success con cerning the main objective.…”