Abstract

Objectives: In this study, we aimed to evaluate the outcome and the long term complication rates of ureteroscopy for stones in distal, middle, and proximal ureter.

Material and Methods: Medical records of all patients treated with ureteroscopy for ureteral stones between July 2000 and December 2002 were retrospectively reviewed. Patient characteristics, surgical parameters, and complications were compared for stones in distal, middle and proximal ureter. The stone size and operation time were compared with one-way ANOVA test and the success and complication rates between the distal, middle, and proximal ureteral stones were compared with chi-square test.

Results: A total of 140 procedures were performed on 127 patients. Ninety-four stones were localized in the distal, 22 in the middle and 24 in the proximal ureter. The mean stone size was 10±5 mm. The operation time ranged between 15 and 300 minutes. The stone size and operation time were significantly higher in proximal stones when compared to the distal ureteral stones (p=0.025, and p=0.032, respectively). In 80 procedures stones were fragmented with pneumatic lithotripsy. In 107 procedures (76.4%) stone clearance was achieved without any further treatment. In 13 procedures (9.3%) residual fragments remained that necessitated further treatment. In 20 procedures (14.3%) ureteroscopy failed. The success, residual fragment and failure rates were 87.2%, 9.6%, and 3.2% for distal, 77.3%, 4.5%, and 18.2% for middle and 33.3%, 12.5%, and 54.2% for proximal stones. The differences between middle and proximal and distal and proximal stones were significant (p=0.0028, and p<0.001, respectively). Immediate or early complications were encountered in 18 procedures (12.9%). One patient with a solitary kidney and one patient who had simultaneous bilateral ureteroscopy developed anuria and both patients were treated by ureteral stenting in the early postoperative period. The complication rates were 9.6%, 18.2%, and 20.8% for distal, middle and proximal stones, respectively. The differences for the complication rates were not significant (p>0.05). The mean follow-up time was 12 months. In the long term follow-up 2 patients had ureteral stricture. One of these patients had a proximal and the other middle ureteral stone.

Conclusions: The success rate was lower for proximal ureteral stones than the other 2 groups. The complication rate, though not statistically significant, was higher in middle and proximal stones than it was for distal ureteral stones. Patients treated for middle and proximal ureteral stones should be followed radiologically for long term ureteral stenosis. Postoperative stenting is advisable after simultaneous bilateral procedures or for patients with a solitary kidney.