Ureterorenoscopy in treating ureteral calculi: experience of Croatian Reference Center for Urolithiasis
Radoja I, Sudarević B, Šimunović D, Kuveždić H.
Department of Urology, University Hospital Center Osijek, Osijek, Croatia
Initial treatment for patients with ureteral stones are extracorporeal shock-wave lithotripsy (SWL) and ureterorenoscopy (URS). The aim of this study was to present our results of URS in treating ureteral calculi and to analyze stone-free rate (SFR) and complications.
Patients and Methods
We have analyzed 210 out of 777 patients who had URS at our Department from 1987 to 2013. URS was performed with Storz semirigid ureterorenoscope, using electrokinetic and rarely ultrasonic lithotripsy. Mean age of the patients was 54 years (12-82 years). Male to female ratio was 0.93. Stones were located proximally in 21.9%, mid-ureteral in 29.5% and distally in 48.6%. Median stone size was 10 mm (2-90 mm). Comorbidities were present in 58% patients (arterial hypertension 74.6%). 51% of the patients had previous SWL treatment. SFR was determined as complete abscence of stone fragments on plain abdominal film and ultrasonography after URS treatment.
Overall SFR was 77.14%, with 58.7% for proximal, 79% for mid-ureteric and 84.3% for distal calculi. 41% of the patients required JJ stent. In 58.3% of non stone-free patients additional SWL session was sufficient for complete stone clearance (modified overall SFR was 90.5%). The rest had clinically insignificant residual fragments and were monitored or they had several SWL sessions. Complications were noted in 23 patients: 13 had fever, 6 required percutaneous nephrostomy and 4 open surgery.
URS is initial treatment option for younger patients and it is safe and effective in removing ureteral stones, because of low retreatment and complication rate.