Anđelo Mojsović, Daniel Reljic, Marin Paic and Marinko Bošnjak
Department of Surgery and Urology, General Hospital of Sibenik, Croatia
INTRODUCTION AND OBJECTIVES: The development of ureterorenoscopy tehniques, especialy lately with introduction of flexible ureterorenoscope have greatly diminished the need for open surgery in treatment of ureteral stones. Although ESWL is considered to be the first choice of treatment for stones in pyelon, our experiance support successful use of ureterorenoscopic treatment even in such cases. We reveiwed our ten years experiance with ureterorenoscopic treatment of ureteral stones during period between 2001. and 2011..
MATERIALS AND METHODS: Retrospectively, we analyzed the medical records of 628 patients with ureteral and renal calculi treated ureterorenoscopicaly between January 01.2001. and December 31.2011. in our hospital. Ureterorenoscopies were performed by semi-rigid ureterorenoscope and we have been using pneumatic lithotriptor – Lithoclast, and occasionally forceps grasps or basket for extraction fragments of stones. Flexibile ureterorenoscope we have been using only in period of last eleven months.
RESULTS: We treated 628 patients with ureteral stone, 333 patients has distal ureteral stone (53,02 %), 141 patients mid ureteral stone (22,45 %) and 154 patients (24,52%) has proximal ureteral and renal stones. Stone removal was successful in 534 patients (85,03%), 301 patients with distal ureteral stone (90,39%), 115 patients with mid ureteral stone (81,56%) and 118 patients with proximal ureteral and renal stones (76,62 %). Unsuccessful ureterorenoscopic treatment in 94 patient were in most cases due to edema or stenosis of ureter. Those patients were later treated by repeateded ureterorenoscopy (41 patients), ESWL (12 patients), open surgery or PCNL (8 patients). In 33 patients was noted postoperative spontaneus elimination of stone. There were no major complications such as ureteral perforation, and in 54 patients were noted fever and pain postoperatively.
CONCLUSIONS: Ureterorenoscopy is safe, highly effective and inexpensive method for treatment ureteral stones even for calculi in proximal ureter and pyelon. Ureterorenoscopy have greatly diminished the need for open surgery in treatment of ureteral stones and it is well alternative to ESWL, especially for a small hospital such is General Hospital of Sibenik, Croatia. Introduction of flexibile ureterenoscopy in combination with laser desintegration almost elminated need for any open surgery and ESWL in treatment urinary stones.