Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones.
OBJECTIVE
To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction.


METHODS
The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes.


RESULTS
Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction.


CONCLUSIONS
Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality.
Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands. j.d.legemate@amc.uva.nl.
Jaap D
JD
Legemate
Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
Nienke J
NJ
Wijnstok
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
Tadashi
T
Matsuda
Department of Urology, Zuyderland Medisch Centrum Parkstad, Heerlen, The Netherlands.
Willem
W
Strijbos
Department of Urology, Memorial Istanbul Atasehir Hospital, Istanbul, Turkey.
Tibet
T
Erdogru
Department of Urology, University Hospital Bern, Bern, Switzerland.
Beat
B
Roth
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
Hidefumi
H
Kinoshita
Department of Urology, Hospital Galdakao-Usansolo, Vizcaya, Spain.
Judith
J
Palacios-Ramos
Department of Urology, University of Turin, Turin, Italy.
Roberto M
RM
Scarpa
Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
Jean J
JJ
de la Rosette
D000328:Adult; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D016896:Treatment Outcome; D014513:Ureter / Q000473:pathology / Q000601:surgery; D014514:Ureteral Calculi / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014517:Ureteral Obstruction / Q000209:etiology / Q000601:surgery; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods
Complications; Impacted stones; Treatment outcomes; Ureter; Ureteroscopy; Urolithiasis