ENDOSCOPIC MANAGEMENT OF IMPACTED URETERAL STONES USING A SMALL CALIBER URETEROSCOPE AND A LASER LITHOTRIPTOR
- 1 August 2000
- journal article
- Published by Wolters Kluwer Health in Journal of Urology
- Vol. 164 (2), 329-331
- https://doi.org/10.1016/s0022-5347(05)67352-1
Abstract
We reviewed our experience with retrograde endoscopy using a small caliber ureteroscope and a laser lithotriptor in 104 consecutive patients with impacted ureteral stones and also analyzed the associated endoscopic findings. From July 1993 to October 1999 we performed retrograde endoscopic treatment in 104 patients with impacted ureteral stones. Average maximum stone diameter was 15.2 mm. (range 2 to 110), and 9 patients had stones larger than 3 cm. Mean duration of impaction was more than 14 months and the longest was 10 years. We used 6.9Fr rigid or 6.9 to 7.5Fr flexible ureteroscopes and a pulsed dye laser or holmium:YAG laser lithotriptor. Of the 104 ureteral stones 100 (96.2%) were completely fragmented by a single endoscopic procedure. Although 1 uric acid stone could not be disintegrated by either the pulsed dye laser or electrohydraulic lithotripsy early in this series, it was discharged spontaneously 2 weeks after the procedure. Additional extracorporeal shock wave lithotripsy (ESWL*) was required in 3 patients who initially had stones larger than 3 cm. A month after treatment no patient had evidence of residual stones. Using adjuvant ESWL a 100% success rate was attained with minimal morbidity. Endoscopic observation revealed inflammatory polyps of the ureter in 22 patients (21.2%), and stricture adjacent to the stone in 16 (15. 4%). There were no significant complications. Using a small caliber ureteroscope and a laser lithotriptor we could treat the target stone in all 104 patients with adjuvant ESWL in 3 cases. Endoscopic lithotripsy seems to be effective first line therapy for chronically impacted stones which are frequently associated with chronic inflammation, polyps and strictures, and avoids the futile repetition of ESWL and problems related to the prolonged passage of stone fragments.Keywords
This publication has 18 references indexed in Scilit:
- URETERAL STRICTURE FORMATION AFTER REMOVAL OF IMPACTED CALCULIJournal of Urology, 1998
- CONTEMPORARY MANAGEMENT OF URETERAL STONESUrologic Clinics of North America, 1997
- Ureteroscopy: Current Practice and Long-Term ComplicationsJournal of Urology, 1997
- Ureteroscopic Removal of Mid and Proximal Ureteral CalculiJournal of Urology, 1996
- A 7.5/8.2 F actively deflectable, flexible ureteroscope: A new device for both diagnostic and therapeutic upper urinary tract endoscopyUrology, 1994
- Stone Granuloma: A Cause of Ureteral StrictureJournal of Urology, 1993
- A Modified Algorithm for the Management of Ureteral Calculi: 100 Consecutive CasesJournal of Urology, 1988
- Extracorporeal Shock Wave Lithotripsy of Ureteral Stones: Clinical Experience and Experimental FindingsJournal of Urology, 1986
- Percutaneous Management of Ureteral Calculi Facilitated by Retrograde Flushing with Carbon Dioxide or Diluted Radiopaque DyeJournal of Urology, 1985
- Use of retrograde occlusion balloon catheters in percutaneous removal of renal calculiUrology, 1985