title: 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.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Ureteroscopy was performed according to study protocol and local clinical practice guidelines.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  RESULTS
  This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.
authors: Department of Urology, Clínica La Luz, Madrid, Spain.
authors: Enrique
authors: E
authors: Perez Castro
authors: Department of Urology, Fredericia Hospital (part of Hospital Littlebelt, University of Southern Denmark), Fredericia, Denmark.
authors: Palle J S
authors: PJ
authors: Osther
authors: Department of Urology, Prof. Dr. Th. Burghele Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors: Viorel
authors: V
authors: Jinga
authors: Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors: Hassan
authors: H
authors: Razvi
authors: Department of Urology, Athens Medical School, Laiko Hospital, Athens, Greece.
authors: Konstantinos G
authors: KG
authors: Stravodimos
authors: Department of Urology, Shyam Urosurgical, Ahmedabad, India.
authors: Kandarp
authors: K
authors: Parikh
authors: Department of Urology, Bilim University, Istanbul, Turkey.
authors: Ali R
authors: AR
authors: Kural
authors: Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. Electronic address: j.j.delarosette@amc.uva.nl.
authors: Jean J
authors: JJ
authors: de la Rosette
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019233:Retreatment; D012955:Societies, Medical; D017211:Treatment Failure; D014513:Ureter / Q000473:pathology*; D014514:Ureteral Calculi / Q000473:pathology* / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects / Q000295:instrumentation; D055815:Young Adult
keywords: Complications; Treatment outcome; Ureteral stones; Ureteroscopy