Ureteroscopic Management of Ureteral Calculi
Koleski F, Turk T, Albala D

INTRODUCTION: Current development in instrumentation and in intracorporeal lithotripsy devices allows for the reliable management of a variety of urinary tract diseases in a minimally invasive way.

OBJECTIVES: Determine the safety and effectiveness of ureteroscopy for the management of the ureteral calculi.

MATERIALS AND METHODS: The complete charts of 97 patients who underwent 100 ureteroscopic procedures at Loyola University Medical Center between 12/96 and 12/98 were reviewed. All patients had a pre-operative intravenous pyelography (IVP) or computed tomography (CT) scan. Length of pre- and post-operative stenting time, location of the calculi, type of ureteroscope and retrieval method utilized [basketing alone, electrohydraulic lithotripsy (EHL) or holmium laser lithotripsy (HLL)], calculi composition, success and complication rates were collected. Success rate was defined as absence of the ureteral stone in a post-operative plain abdominal radiography, IVP or CT scan.

RESULTS: Most of the stones were located in the distal ureter (48.5%), while 24.7% and 26.8% of the stones were respectively located in mid and upper ureter. Overall stone free status after the first procedure was 84.5%, ranging from 74.5% for EHL up to 100% for HLL. EHL was least successful in the upper ureter (47.5%). Minor complications were present in 7.2% of the cases. One major complication (perforation) occurred in the distal ureter with EHL use.

CONCLUSIONS: Ureteroscopy with the current available instruments for stone manipulation and lithotripsy devices allows the urologist to manage effectively ureteral calculi. Despite costs, HLL is related to higher success rates and less complications when compared to EHL. Minor complications, when present, can be managed successfully in a conservative fashion.

Journal of Endourology, Vol. 13 Supplement 1, A122 Sep 1999

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