Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones.
BACKGROUND
Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones.


METHODS
From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2.


RESULTS
In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket (51.6%). Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%.


CONCLUSIONS
Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope.
Department of Urology, Punan Hospital, Shanghai 200125, China.
Ding-Yi
DY
Liu
Hong-Chao
HC
He
Jian
J
Wang
Qi
Q
Tang
Yan-Feng
YF
Zhou
Ming-Wei
MW
Wang
Cheng-Long
CL
Chu
Chong-Yu
CY
Zhang
Yu
Y
Zhu
Wen-Long
WL
Zhou
Zhou-Jun
ZJ
Shen
D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D017602:Lithotripsy, Laser / Q000379:methods*; D008875:Middle Aged; D014514:Ureteral Calculi / Q000628:therapy*; D055815:Young Adult