title: Lubriglide Sequential Ureteral Dilators®: A Safe and Effective Method of Ureteral Dilation.
abstract: During ureteroscopy (URS), ureteral dilation may be required to increase the likelihood of accessing the ureter to complete the procedure. Thus, we sought to assess the safety and efficacy of using Lubriglide sequential ureteral dilators®(Boston Scientific) to promote primary URS, without need for prestenting.
  
  
  
  Retrospective review was performed of a consecutive series of patients undergoing primary URS by a single surgeon (N.L.M.) from 2011 to 2013. The primary outcomes were to characterize the use, safety, and efficacy of sequential ureteral dilators to promote stone treatment during URS.
  
  
  
  A total of 316 nonprestented cases of primary URS were attempted over the study period. Use of sequential ureteral dilators to promote ureteral access was performed in 109 (34.5%) cases and was effective to allow completion of the procedure in 102 (93.6%) cases. No intraoperative complications occurred while performing sequential ureteral dilation. Fourteen patients (4.3%) required ureteral stent placement for passive ureteral dilation, with definitive stone treatment at a later date. Postoperative radiographic follow-up was available for 272 (86.1%) cases, and no ureteral strictures were detected in the ureteral dilation group. On multivariate analysis, both a history of prior extracorporeal shockwave lithotripsy [odds ratio (OR) 0.45, confidence interval (CI) 0.25, 0.81, p = 0.008] and prior URS (OR 0.42, CI 0.25, 0.70, p = 0.001) were inversely associated with need to perform ureteral dilation.
  
  
  
  Approximately 1/3 of nonprestented patients may require ureteral dilation for effective completion of primary URS. Use of sequential ureteral dilators may significantly decrease the need for prestenting and a secondary procedure to complete stone treatment. Thus, we conclude that sequential ureteral dilators represent a safe and effective method to perform ureteral dilation to promote ureteral access and allow for effective stone treatment in one setting.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mitchell
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kuebker
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Benjamin
authors.initials: B
authors.lastname: McCormick
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Tracy
authors.initials: T
authors.lastname: Marien
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014513:Ureter / Q000473:pathology*; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000295:instrumentation* / Q000379:methods
keywords: nephrolithiasis; stone disease; ureteral dilation; ureteral dilators; ureteroscopy