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Eur Urol. 2014 Jul;66(1):102-9. doi: 10.1016/j.eururo.2014.01.011. Epub 2014 Jan 23.

Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study.

Author information

1
Department of Urology, Clínica La Luz, Madrid, Spain.
2
Department of Urology, Fredericia Hospital (part of Hospital Littlebelt, University of Southern Denmark), Fredericia, Denmark.
3
Department of Urology, Prof. Dr. Th. Burghele Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
4
Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
5
Department of Urology, Athens Medical School, Laiko Hospital, Athens, Greece.
6
Department of Urology, Shyam Urosurgical, Ahmedabad, India.
7
Department of Urology, Bilim University, Istanbul, Turkey.
8
Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. Electronic address: j.j.delarosette@amc.uva.nl.

Abstract

BACKGROUND:

Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.

OBJECTIVE:

To describe the differences in the treatment and outcomes of ureteroscopic stones in different locations.

DESIGN, SETTING, AND PARTICIPANTS:

Prospective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period.

INTERVENTION:

Ureteroscopy was performed according to study protocol and local clinical practice guidelines.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Stone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations.

RESULTS AND LIMITATIONS:

Between January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n=2656), midureter (n=1980), distal ureter (n=4479), or multiple locations (n=440); location in 126 patients was not specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8-7.7%). Postoperative complications occurred in 2.5-4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include short-term follow-up and a nonuniform treatment approach.

CONCLUSIONS:

Ureteroscopy for ureteral stones resulted in good stone-free rates with low morbidity.

PATIENT SUMMARY:

This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.

KEYWORDS:

Complications; Treatment outcome; Ureteral stones; Ureteroscopy

PMID:
24507782
DOI:
10.1016/j.eururo.2014.01.011
[Indexed for MEDLINE]

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