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The Impact of Stone Location on Ureteroscopy Success Rates with the Use of Modern Day Ureteroscopes
Adam E Perlmutter, Can Talug, Stanley Zaslau, William Tarry, Stanley Kandzari
West Virginia University, Morgantown, WV
Introduction: To determine if stone location impacts stone-free rates when modern day ureteroscopes are utilized.
Methods: From January 2002 to August 2006, 185 patients with 207 stones, ranging from 4 mm to 20 mm in size, underwent ureteroscopy with laser lithotripsy at West Virginia University Hospital. Patients were followed postoperatively with computed tomography scan, abdominal plain film, renal ultrasound or retrograde pyelogram. Patients were considered to be treated successfully if they had no residual stones greater than 3 mm in size and did not require any further stone surgery. Pediatric patients and all patients with stones greater than 2 cm were excluded. Also, patients who had prior extracorporeal shock wave lithotripsy, percutaneous nephrolithotripsy or ureteroscopy by an outside urologist were excluded.
Results: A total of 207 stones were treated with ureteroscopy and laser lithotripsy. One hundred ninety-two patients (93.2%) were successfully treated. Fourteen patients (6.8%) either had persistent stones greater than 3 mm or required repeat surgery for nephroureterolithiasis. All 18 upper pole stones (100%) were cleared, 22 of 25 middle pole stones (88%) were cleared, 40 of 44 lower pole stones (90.9%) were cleared (p=0.338). Of the ureteral stones, 37 of 40 proximal stones (92.5%) were cleared, 29 of 32 midureteral stones (91%) were cleared and 47 of 48 distal ureteral stones (98%) were cleared (p=0.339).
Conclusions: Ureteroscopy has been an important tool for treating nephroureterolithiasis with excellent success rates and minimal morbidity. Modern day ureteroscopes minimize the impact of stone location on stone-free rates.
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