Safety and efficacy of ureteroscopy for the treatment of large impacted proximal ureteralstones
Authors:   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Petrov Petar , Todorova Viktoria ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Hristov Konstantin ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Gatsev Ognyan ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Petkova Kremena ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Saltirov Iliya ,   Clinic of Urology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria, Petrova Daniela ,   Clinic of Nephrology, Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
Published: June 2024

Introduction and objective: Management of large impacted proximal ureteral stones is often challenging due to the presence of mucosal edema, inflammation and angulations of the ureter. Improvements in ureteroscopic technology increased the efficacy and safety of ureteroscopy (URS) as a first-line treatment in large impacted stones in the proximal ureter. The objective of this retrospective study is to evaluate the efficacy and safety of URS for the management of impacted proximal ureteral stones ≥ 10 mm. Material and methods: The medical records of 700 patients with ureteral stones, who underwent ureteroscopy and intracorporeal lithotripsy between January 2016 and Аpril 2024 were retrospectively reviewed. 179 patients had impacted stones ≥ 10 mm located in the proximal ureter – 125 (70%) were stones sized 10÷15 mm and 54 (30%) – stones ≥ 15 mm. URS was performed with 8.6 or 6.4Fr semirigid ureteroscope and Holmium laser. Flexible URS was performed in cases with tortuous ureter or stone retropulsion. Data on patients‘ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients’mean age was 54.1±12.3 years and mean stone size – 14.7±.4.8 mm. 30 % of the patients had previous unsuccessful shock- wave lithotripsy of the stone. Mean operative time was 45.1±15.7 min min and overall success rate – 85.3%. 66.2% of patients were treated with semirigid URS and 33.8% – with flexible URS. On subgroup analysis patients with stones 10÷15 mm and patients with stones ≥ 15 mm had similar preoperative characteristics. Success rate after a single procedure was higher and operating times significantly shorter in the subgroup of stones sized 10÷15 mm (87.1% vs 71.3%, p=0.159 and 41.3±12.9 vs 53.3±21.3 min, p=0.040,respectively). There were no statistically significant differences between the two subgroups in intraoperative stent JJ placement (34.1% vs 50.0%, p=0.400), stone retropulsion (21.3% vs 23.1%, p=0.847) and overall postoperative complications rate (9.3% vs 0%, p=0.161). Conclusion: The results of this study suggest that URS is a safe and effective treatment for management of patients with large impacted proximal ureteral stones. Larger stone size was a predictor of lower success rate after a single procedure.