A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm

Elias S. Hyams, Manoj Monga, Margaret S Pearle, Jodi Antonelli, Michelle J. Semins, Dean G. Assimos, James E. Lingeman, Vernon M. Pais, Glenn M. Preminger, Michael E. Lipkin, Brian H. Eisner, Ojas Shah, Roger L. Sur, Patrick W. Mufarrij, Brian R. Matlaga

Research output: Contribution to journalArticle

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Abstract

PURPOSE: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.

MATERIALS AND METHODS: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.

RESULTS: Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.

CONCLUSIONS: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.

Original languageEnglish (US)
Pages (from-to)165-169
Number of pages5
JournalThe Journal of urology
Volume193
Issue number1
DOIs
StatePublished - Jan 1 2015

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Ureteroscopy
Kidney
Laser Lithotripsy
Ureteral Calculi
Kidney Calculi
Urinary Retention
Intraoperative Complications
Solid-State Lasers
Pulmonary Edema
Ureter
Operative Time
Urinary Tract Infections
Stents
Urinary Bladder
Lasers
Body Mass Index
X-Rays
Morbidity
Wounds and Injuries

Keywords

  • calculi
  • diagnostic imaging
  • kidney
  • ureter
  • ureteroscopy

ASJC Scopus subject areas

  • Urology

Cite this

A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. / Hyams, Elias S.; Monga, Manoj; Pearle, Margaret S; Antonelli, Jodi; Semins, Michelle J.; Assimos, Dean G.; Lingeman, James E.; Pais, Vernon M.; Preminger, Glenn M.; Lipkin, Michael E.; Eisner, Brian H.; Shah, Ojas; Sur, Roger L.; Mufarrij, Patrick W.; Matlaga, Brian R.

In: The Journal of urology, Vol. 193, No. 1, 01.01.2015, p. 165-169.

Research output: Contribution to journalArticle

Hyams, ES, Monga, M, Pearle, MS, Antonelli, J, Semins, MJ, Assimos, DG, Lingeman, JE, Pais, VM, Preminger, GM, Lipkin, ME, Eisner, BH, Shah, O, Sur, RL, Mufarrij, PW & Matlaga, BR 2015, 'A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm', The Journal of urology, vol. 193, no. 1, pp. 165-169. https://doi.org/10.1016/j.juro.2014.07.002
Hyams, Elias S. ; Monga, Manoj ; Pearle, Margaret S ; Antonelli, Jodi ; Semins, Michelle J. ; Assimos, Dean G. ; Lingeman, James E. ; Pais, Vernon M. ; Preminger, Glenn M. ; Lipkin, Michael E. ; Eisner, Brian H. ; Shah, Ojas ; Sur, Roger L. ; Mufarrij, Patrick W. ; Matlaga, Brian R. / A prospective, multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm. In: The Journal of urology. 2015 ; Vol. 193, No. 1. pp. 165-169.
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AU - Hyams, Elias S.

AU - Monga, Manoj

AU - Pearle, Margaret S

AU - Antonelli, Jodi

AU - Semins, Michelle J.

AU - Assimos, Dean G.

AU - Lingeman, James E.

AU - Pais, Vernon M.

AU - Preminger, Glenn M.

AU - Lipkin, Michael E.

AU - Eisner, Brian H.

AU - Shah, Ojas

AU - Sur, Roger L.

AU - Mufarrij, Patrick W.

AU - Matlaga, Brian R.

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N2 - PURPOSE: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.MATERIALS AND METHODS: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.RESULTS: Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.CONCLUSIONS: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.

AB - PURPOSE: Flexible ureteroscopy is rapidly becoming a first line therapy for many patients with renal and ureteral stones. However, current understanding of treatment outcomes in patients with isolated proximal ureteral stones is limited. Therefore, we performed a prospective, multi-institutional study of ureteroscopic management of proximal ureteral stones smaller than 2 cm to better define clinical outcomes associated with this approach.MATERIALS AND METHODS: Adult patients with proximal ureteral calculi smaller than 2 cm were prospectively identified. Patients with concomitant ipsilateral renal calculi or prior ureteral stenting were excluded from study. Flexible ureteroscopy, holmium laser lithotripsy and ureteral stent placement was performed. Ureteral access sheath use, laser settings and other details of perioperative and postoperative management were based on individual surgeon preference. Stone clearance was determined by the results of renal ultrasound and plain x-ray of the kidneys, ureters and bladder 4 to 6 weeks postoperatively.RESULTS: Of 71 patients 44 (62%) were male and 27 (38%) were female. Mean age was 48.2 years. ASA(®) score was 1 in 12 cases (16%), 2 in 41 (58%), 3 in 16 (23%) and 4 in 2 (3%). Mean body mass index was 31.8 kg/m(2), mean stone size was 7.4 mm (range 5 to 15) and mean operative time was 60.3 minutes (range 15 to 148). Intraoperative complications occurred in 2 patients (2.8%), including mild ureteral trauma. Postoperative complications developed in 6 patients (8.7%), including urinary tract infection in 3, urinary retention in 2 and flash pulmonary edema in 1. The stone-free rate was 95% and for stones smaller than 1 cm it was 100%.CONCLUSIONS: Flexible ureteroscopy is associated with excellent clinical outcomes and acceptable morbidity when applied to patients with proximal ureteral stones smaller than 2 cm.

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