Ureterorenoscopic treatment of urolithiasis in general hospital šibenik

Ureterorenoscopic treatment of urolithiasis in general hospital šibenik

Marinko Bošnjak, Anđelo Mojsović, Marin Paić, Daniel Reljić,

Department of Surgery and Urology, General Hospital Šibenik

Introduction: Development of ureterorenoscopic techniques and equipment has completely eliminated the need for open surgical approach in the treatment of ureteral calculi . Also, today neither ESWL can no longer be considered the method of choice for the treatment of ureterolithiasis. In OB Šibenik we started ureterorenoscopic treatment of our patients 1998th year, and from our own experience over the last 16 years , we can conclude that ureterorenoscopy is method of first choice in the treatment of ureteral stones, including cases of the concrement in the proximal portion of the ureter .

Materials and methods: We have processed the data from our operational protocols related to ureterorenoscopic removal of ureteral calculi for the period from 1 January 2001th to 31st December 2013. Ureterorenoscopic operations were conducted with semi-rigid ureteroscope 6F and for destruction of calculi we used pneumatic lithotriptor Lithoclast . In some cases, were used endoscopic grips or baskets to pull the fragments. As successful, we considered all patients without obstruction after intervention. Not only a “ stone- free “, but also those who had residual fragment in the canal system of kidney and even those cases when we managed only “ push -back procedures “ of concrement back into the kidney. In such cases, patients continued treatment by some other method ( ESWL or PCNL ) or repeated URS intervention after a few days . Unsuccessful interventions we declared those in which we failed to resolve the obstruction, usually because the instrument has failed to reach the calculus in the ureter. The patients were divided into three groups according to the localization of concrement; those who had stones in the distal , middle and proximal ureter . When assessing the localization of concrement, proximal ureter is considered part from the PU segment to 2 cm above the SI joint, the middle part of the ureter is 2 cm above to 2 cm below the SI joint and the distal part of the ureter 2 cm below the SI joint to UV junction .

Results: In this period of 13 years we have treated 711 patients with ureterolithasis . A total of 363 patients ( 51 % ) had a distal concrement , 163 patients (23 %) had a concrement in the middle , and 185 patients (26 % ) had a concrement in the proximal portion of the ureter . Successful removal of calculi occurred in a total of 614 patients ( 86 % ) . Since then , the successful removal was reported in 328 cases ( 90 % ) when concrement was in the distal ureter . In the middle part of the ureter, the successful removing of concrement was in the 139 patients ( 85 % ) . In the case of lithiasis in the proximal portion of the ureter removal was successful in 147 patients (79 % ).

Conclusion: Ureterorenoscopy is safe, highly effective and relatively inexpensive method for resolving ureterolithiasis. Ureterorenoscopy entirely eliminates the need for conventional surgical operative treatment, and significantly reduced the need for ESWL treatment. Today is the first method of choice for the treatment of ureteral stones, suitable for smaller hospitals such as the General Hospital Šibenik . In the future, new technology will bring more tratment options. With introduction of flexible ureteroscope and Holmium laser in use in our hospital, we will get the option of ureterorenoscopic treatment of smaller kidney stones and not just stones in the ureter . We believe that in the future combination of semi-rigid and flexible ureterorenoscopy using lasers and progress of techniques and equipment with the acquisition of skills and experience will enable treatment more than 90 % of all patients with urolithiasis in our hospital .

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