title: A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm.
abstract: OBJECTIVE
  Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.
  
  
  METHODS
  Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.
  
  
  RESULTS
  Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.
  
  
  CONCLUSIONS
  Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Elias S
authors.initials: ES
authors.lastname: Hyams
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Pearle
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jodi A
authors.initials: JA
authors.lastname: Antonelli
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Semins
authors.affiliation: University of Alabama Birmingham, Birmingham, Alabama.
authors.forename: Dean G
authors.initials: DG
authors.lastname: Assimos
authors.affiliation: Indiana University Health, Indianapolis, Indiana.
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
authors.affiliation: Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Pais
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Lipkin
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Eisner
authors.affiliation: New York University Langone Medical Center, New York, New York.
authors.forename: Ojas
authors.initials: O
authors.lastname: Shah
authors.affiliation: University of California-San Diego, San Diego, California.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Sur
authors.affiliation: George Washington University Medical Center, Washington, D.C.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Mufarrij
authors.affiliation: Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address: bmatlaga@jhmi.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000473:pathology / Q000601:surgery*; D018666:Ureteroscopy
keywords: calculi; diagnostic imaging; kidney; ureter; ureteroscopy