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Perez Castro E et al, 2014: Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosette JJ; on behalf of the CROES Ureteroscopy Global Study Group
Department of Urology, Clínica La Luz, Madrid, Spain
Department of Urology, Fredericia Hospital (part of Hospital Littlebelt, University of Southern Denmark), Fredericia, Denmark
Department of Urology, Prof. Dr. Th. Burghele Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
Department of Urology, Athens Medical School, Laiko Hospital, Athens, Greece
Department of Urology, Shyam Urosurgical, Ahmedabad, India
Department of Urology, Bilim University, Istanbul, Turkey
Department of Urology, AMC University Hospital, Amsterdam, The Netherlands


Abstract

BACKGROUND: Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.

OBJECTIVE: To describe the differences in the treatment and outcomes of ureteroscopic stones in different locations.

DESIGN,SETTING, AND PARTICIPANTS: Prospective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period.

INTERVENTION: Ureteroscopy was performed according to study protocol and local clinical practice guidelines.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Stone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations.

RESULTS AND LIMITATIONS: Between January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n=2656), midureter (n=1980), distal ureter (n=4479), or multiple locations (n=440); location in 126 patients was not specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8-7.7%). Postoperative complications occurred in 2.5-4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include short-term follow-up and a nonuniform treatment approach.

CONCLUSIONS: Ureteroscopy for ureteral stones resulted in good stone-free rates with low morbidity.

PATIENT SUMMARY: This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient.

Eur Urol. 2014 Jan 23. pii: S0302-2838(14)00023-2. doi: 10.1016/j.eururo.2014.01.011. [Epub ahead of print]
PMID:24507782[PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Tuesday, 22 April 2014 06:08

Although this article not at all deals with SWL, it is nevertheless of interest in this regard. The reason is that for removal of ureteral stones SWL is commonly compared with URS. In this multicentre report from CROES Ureteroscopy Study Group, the results of 9676 ureteroscopic procedures of single as well as multiple stones in the proximal, mid and distal ureter are summarized.

When reading articles that compare non-invasive and endoscopic removal of ureteral stones, it is easy to get the impression that URS almost always results in stone-free ureters without re-treatment and essentially without any significant complications.

It is thus interesting to note that in this series of ureteroscopic stone removing procedures carried out by urologists with particular expertise in this technique, stone-free rates varied between 76.6 and 94.2%, the latter percentage for distal ureteral stones. Moreover, there were re-treatment rates between 5.1 and 18.2%. The reported intra-operative complications varied between 3.8 and 7.7% and postoperative complications between 3.3 and 8% (when also those patients are included who were treated for multiple stones). The overall complication rate thus varied between 7.1 and 15.7%. Similar to what is the case with SWL, stone-free rates decreased with stone size.

Although the results in this large series of patients, undoubtedly, are good, the data referred to above and summarized in the table, should be kept in mind when a non-invasive treatment strategy is compared with an invasive approach.

Stone-free rates --> 76.6 – 94.2 %
Re-treated patients --> 5.1 – 18.2 %
Complications --> 7.1 – 15.7 %

Hans-Göran Tiselius

Although this article not at all deals with SWL, it is nevertheless of interest in this regard. The reason is that for removal of ureteral stones SWL is commonly compared with URS. In this multicentre report from CROES Ureteroscopy Study Group, the results of 9676 ureteroscopic procedures of single as well as multiple stones in the proximal, mid and distal ureter are summarized. When reading articles that compare non-invasive and endoscopic removal of ureteral stones, it is easy to get the impression that URS almost always results in stone-free ureters without re-treatment and essentially without any significant complications. It is thus interesting to note that in this series of ureteroscopic stone removing procedures carried out by urologists with particular expertise in this technique, stone-free rates varied between 76.6 and 94.2%, the latter percentage for distal ureteral stones. Moreover, there were re-treatment rates between 5.1 and 18.2%. The reported intra-operative complications varied between 3.8 and 7.7% and postoperative complications between 3.3 and 8% (when also those patients are included who were treated for multiple stones). The overall complication rate thus varied between 7.1 and 15.7%. Similar to what is the case with SWL, stone-free rates decreased with stone size. Although the results in this large series of patients, undoubtedly, are good, the data referred to above and summarized in the table, should be kept in mind when a non-invasive treatment strategy is compared with an invasive approach. Stone-free rates --> 76.6 – 94.2 % Re-treated patients --> 5.1 – 18.2 % Complications --> 7.1 – 15.7 % Hans-Göran Tiselius
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