Ureteroscopy Outcomes, Complications and Management of Perforations in Impacted Ureter Stones

Objective To evaluate ureteroscopy (URS) outcomes and management of perforations in impacted ureteral stones. Materials and Methods We retrospectively evaluated data from 81 patients who had undergone URS for impacted ureteral stones. Per-operative complications were evaluated visually and retrograde ureterography was performed when needed. Injuries of less than 50% around the ureter were classified as minor perforation and greater levels, as major perforation. Perforations were treated by double-j stent or a primary repair with consideration of the perforation grade. Results The stone-free rate was 69% on the first URS attempt and 79% at the end of 3 months. Complications occurred in 34 (42%) patients. Minor perforation occurred in five patients and only double-j insertion was performed at the end of the procedure. Permanent ureteral stricture occurred in four of five patients. Three patients were treated by open ureterolithotomy, fibrotic segment resection and ureteroureterostomy due to major perforations. Transient or permanent ureteral stricture occurred in none of the three patients. The stricture rate was significantly higher in patients who were treated with double-j stent (80% vs. 0% p=0.028) although they had lower perforation rate. Upper location, bigger size (>10 mm) of the ureteral stones and not using smash and go strategy were found to be significant predictors of complications. Conclusion URS for impacted ureteral stone has low success and high complication rates, especially for proximal and big stones. The conservative treatment may fail and result in stricture when perforation is present. Therefore, perforation treatment must be done by fibrotic segment excision and ureteroureterostomy.