Primary Ureteroscopy without Pre-Stenting for Proximal Ureteral Stones—Is It Feasible?
Author:
Lazarovich Alon12ORCID, Haramaty Rennen12, Shvero Asaf12, Zilberman Dorit E.12ORCID, Dotan Zohar A.12ORCID, Winkler Harry12, Kleimann Nir12
Affiliation:
1. Department of Urology, Chaim Sheba Medical Center, Ramat Gan 5266202, Israel 2. The School of Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
Abstract
Background: Primary ureteroscopy with laser lithotripsy is the treatment of choice for distal ureteral stones. However, in cases of proximal ureteral stones, some urologists recommend the preliminary insertion of a ureteral stent and deferred ureteroscopy. We aimed to evaluate the necessity of preliminary ureteral stent insertion in the management of proximal ureteral stones by comparing the surgical outcomes of patients undergoing primary ureteroscopy with laser lithotripsy for proximal vs. distal ureteral stones. Methods: Medical records of patients who underwent ureteroscopy between 2016 and 2017 in our institution were retrospectively reviewed. Data collected included demographic data, stone size, renal function, intra- and post-operative complications, and stone-free rate (SFR). Patients were divided into two groups: proximal ureteral stones and distal ureteral stones. Results: The cohort included 241 patients who underwent ureteroscopy. Among them, 106 had a proximal ureteral stone. The median age was 51 (IQR 41–65) years. Patients who underwent ureteroscopy for proximal ureteral stones were significantly older (p = 0.007). The median stone’s maximal diameter was 7 (5–10) mm. The complication rate and stone-free rate (SFR) were similar in both groups (p = 0.657 and p = 1, respectively). The prevalence of post-procedural ureteral stent insertion was higher among patients who underwent ureteroscopy for proximal ureteral stones: 92.5% vs. 79.3% (p = 0.004). Conclusions: Our study concludes that primary ureteroscopy with laser lithotripsy for proximal ureteral stones is a valid and feasible treatment with a similar surgical outcome compared to distal ureteral stones. Preliminary ureteral stent insertion seems to be unnecessary.
Funder
Department of Urology at the Chaim Sheba Medical Center
Subject
Paleontology,Space and Planetary Science,General Biochemistry, Genetics and Molecular Biology,Ecology, Evolution, Behavior and Systematics
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