Outcomes of Ureteroscopy for the Management of Impacted Ureteral Calculi With Different Localizations

Değirmenci, Tansu; Günlüsoy, Bülent; Kozacıoğlu, Zafer; Arslan, Murat; Kara, Cengiz; Koraş, Ömer; Minareci, Süleyman

doi:10.1016/j.urology.2012.05.007

Cited by 36 publications

(33 citation statements)

References 22 publications

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“…These numbers decrease as the stone size increases. 1,18,19 In this study, we had a success rate of 82%. In the first 5 patients, the method failed.…”

Section: Discussionmentioning

confidence: 83%

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

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Göktuğ

et al. 2013

CUAJ

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Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones. Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system. Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to be the group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12). Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches. IntroductionUpper ureteral stones, which are hard to treat, are frequently encountered in daily practice. For treatment, the most effective and the safest approach should be chosen. Upper ureteral stones can be managed by various approaches. There is no gold standard treatment for stones between 1 and 2 cm. Even though some researchers recommend extracorporeal shock wave lithotripsy (SWL) as first-line treatment, 1 it has a 40% success rate in larger proximal ureteral calculi.2 With the common use of flexible devices in urology, ureteroscopy has gained popularity in the treatment of upper ureteral stones. For stones larger than 1 cm and fully obstructing the passage in the ureter, open or laparoscopic surgery may be an option with success rates up to 100%.1 In recent years, some authors have published their data on the laparoscopic approach and have recommended its use for its high success and low complication rates. 3This study compares the success and complication rates of SWL and laparoscopic and ureteroscopic approaches for proximal ureteral calculi between 1 and 2 cm. MethodsAfter Institutional Review Board approval, we enrolled 150 patients who had ureteral stones between 1 and 2 cm in the study; they were randomized into 3 groups by an online randomization program (52 for SWL, 51 for laparoscopy, and 48 for retrograde intrarenal surge...

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“…These numbers decrease as the stone size increases. 1,18,19 In this study, we had a success rate of 82%. In the first 5 patients, the method failed.…”

Section: Discussionmentioning

confidence: 83%

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Öztürk

Şener

Göktuğ

et al. 2013

CUAJ

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“…3 The treatment of impacted ureteral calculi are also associated with a greater rate of complications, as well as unsuccessful interventions. 16 In this case, use of a ureteral access sheath was thought to be associated with avulsion of the ureter from the UPJ. Interestingly, Traxer and colleagues reported that ureteral injury is common with ureteral access sheath placement, although they reported no avulsions in the series.…”

Section: Discussionmentioning

confidence: 87%

“…16 In this case, use of a ureteral access sheath was thought to be associated with avulsion of the ureter from the UPJ. Interestingly, Traxer and colleagues reported that ureteral injury is common with ureteral access sheath placement, although they reported no avulsions in the series.…”

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confidence: 87%

Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

Tayeb

Mellon

Lingeman

2015

CUAJ

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E882Cite as: Can Urol Assoc J 2015;9(11-12):E882-5 http://dx.doi.org/10.5489/cuaj.2830 Published online December 14, 2015. AbstractWe present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. IntroductionThe incidence of ureteral injury and overall complications during ureteroscopy ranges from 0 to 28%. [1][2][3][4][5] Iatrogenic ureteral injury varies from minor mucosal petechiae to erosion, perforation, and rarely complete ureteral avulsion. 6 Factors associated with higher complication rates during ureteroscopy are longer surgery times, treatment of renal calculi, surgeon inexperience, and previous irradiation. 1,3,7 Ureteral stents are the cornerstone in the management of ureteral injury. If stent placement is not possible following ureteral injury, placement of a percutaneous nephrostomy tube is required for renal drainage until elective repair can be accomplished. 1,[8][9][10] Several authors have reported reasonable rates of success with ureteroscopic ureteral realignment for iatrogenic ureteral injury during gynecologic and general surgical procedures.9-13 However, to our knowledge, there has not been a previous report of successful endoscopic ureteral realignment following avulsion of the ureter at the level of the ureteropelvic junction. Case reportA 59-year-old female with a long history of nephrolithiasis had a 7-mm right renal pelvic calculus. Ureteroscopic treatment was performed at an outside institution. There was some difficulty with ureteral dilatation and UPJ avulsion of the ureter was suspected associated with insertion of the ureteral access sheath. A safety guide wire was not used during the procedure. Subsequently, a guide wire was not able to be passed beyond the injury into the renal collecting system and, therefore, a stent could not be placed. A 5F ureteral catheter was placed through the avulsed proximal ureter projecting into the retroperitoneum. The patient was transferred to Indiana University Health Methodist Hospital for subsequent management.The patient has a history of cirrhosis, splenomegaly, and thrombocytopenia with a platelet count of 52,000 and an INR of 1.5. Ureteroscopy was performed confirming complete avulsion of the ureter (Fig. 1). A stent could not be placed and a ureteral catheter was replaced into the retroperitoneum near the kidney. The following day a percutaneous nephrostomy was inserted by Interventional Radiology (Fig. 2). The patient was then returned to the operating room and placed in a prone split-leg position to allow for simultaneous antegrade and retrograde access to the ureter. The percutaneous access was dilated to 30F and an Amplatz sheath was positioned into the kidney (Fig. 3). Nephroscopy identified the stone in the renal pelvis which was removed. The UPJ was identified and noted to be very small in caliber. A flexible ureteroscope was passed antegradely through the UPJ confirming that the avu...

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“…Değirmenci ve ark.ları komplikasyon oranlarını pnömotik litotripsi sonrası %13.6'sında 1 veya 2.derece, %15.4'ünde 3 veya 4.derece, Ho:YAG lazer sonrası %15.9'unda 1 veya 2.derece, %7.1'inde 3 veya 4.derece olarak rapor etmişlerdir (7). Komplikasyonlar açısından en önemli risk faktörleri, operasyon süresi, taş yükü (boyutu), taş lokasyonu, tekmultipl taş varlığıdır (5,7).…”

Section: Discussionunclassified

İmpakte Distal Üreter Taşı ile Birlikte Ciddi Distal Üreter Darlığının Tedavisinde Endoskopik Distal Üreter İnsizyonu ve Lazer Litotripsi

Köprü¹,

Demirer²,

Irkılata³

2014

Endouroloji

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GirişÜ riner sistem taş hastalığı toplumda sık görülen bir durumdur. Semptomatik taşların büyük bir kısmı üre-terde saptanan taşlardır ve çoğunlukla böbrekte oluşup daha sonra üretere yerleşirler. Birçok üreter taşı spontan olarak düşer (1). Bir çalışmada 5 mm'nin altındaki distal üreter taşlarının spontan düşme oranı %71-98 olarak bildirilmiştir (2). Üreter taşlarının tedavisinde üreterorenoskopi (URS) ve şok dalga litotripsi (ESWL) ana tedavi modaliteleridir. Ancak özellikle orta ve distal üreter taşlarında en uygun tedavi seçeneği URS iken, ESWL sadece 1 cm'den küçük proksimal üreter taşlarında ilk olarak tercih edilir (3).İmpakte üreter taşı, 1 aydan daha uzun süre üreterde aynı pozisyonda duran, endoskopik olarak taşın kenarından bir kılavuz telin geçmediği veya intravenöz ürografide taşın ilerisinde kontrast medyumun vizüalize olmadığı durum olarak tanımlanır. Genellikle üreterin anatomik darlık bölge-lerinden (üreteropelvik bileşke, iliak damarların çaprazlandı-ğı bölge, üreterovezikal bileşke) birinde lokalize olurlar. İnce kalibreli veya fleksıbl üreteroskopların gelişimi ve holmium: yttrium-aluminum-garnet (Ho:YAG) lazerin kullanımı ile impakte üreter taşlarının tedavisinde URS ile intrakorporeal litotripsi en etkili ve güvenli tedavi modalitesi haline gelmiş-tir.Bu olgu sunumumuzda 2 cm'den büyük impakte distal üreter taşının tedavisinde kullanılan yardımcı bir endoskopik cerrahi yöntem hakkında deneyimimizi paylaşmayı amaçladık. Olgu TakdimiYaklaşık 3 aydan beri sağ yan ağrısı olan 54 yaşında kadın hastanın 1 ay önce başka bir merkezde çekilmiş olan direk üriner sistem grafisi (DÜSG)'nde sağ üreter distaline uyan taş izlenmiş ve üriner ultrasonografi (US)'de 4.derece hidronefroz saptanmıştır. Aynı merkezde 1 seans ESWL tedavisi uygulanmasına rağmen fayda görmeyen hasta polikliniğimi-ze başvurdu. Hastanın merkezimizde çekilen DÜSG'nde sağ üreter alt uça uyan yaklaşık 2.5 cm boyutunda distal üreter taşı tespit edildi. (Resim 1A). Üriner US 4.derece hidroürete-ronefrozun devam ettiğini teyid etti (Resim 1B). Taşın boyutu ve lokalizasyonu göz önüne alınınca hastaya URS eşliğinde lazer litotripsi yapılmasına karar verildi.Genel anestezi sonrası litotomi pozisyonunda hastaya semi-rijid üreterorenoskop ile girildi. Sağ üreter orifisinin ileri derece dar olduğu ve distal üreterdeki taşın mesane içine doğru bir kabarıklığa neden olduğu gözlendi (Resim 2A). Sağ üreter orifisine kılavuz tel gönderilmeye çalışıldı ancak

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Outcomes of Ureteroscopy for the Management of Impacted Ureteral Calculi With Different Localizations

Cited by 36 publications

References 22 publications

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

İmpakte Distal Üreter Taşı ile Birlikte Ciddi Distal Üreter Darlığının Tedavisinde Endoskopik Distal Üreter İnsizyonu ve Lazer Litotripsi

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