Endoscopic treatment of ureteral calculi:: A retrospective study of 215 cases

Purpose: Ureteroscopy (URS) and extracorporeal shock wave lithotripsy are competing means in the treatment of ureteral calculi. Invasiveness, need for general anaesthesia and routine stenting are the major disadvantages of URS. Therefore, URS is still thought to be a method of second choice. We report our experience with URS as "first-line" method in the treatment of ureteral stones. Material and methods: From July 1(st) 1996 to April 30(rd) a total no of 215 ureteroscopic interventions for ureteral calculi was performed in 196 patients (66 female, 130 male). Primary and overall stonefree rate was calculated. Operating time, use of ESWL and other auxiliary means were analysed as well as complications and unsuccessfull operations. Results: We are able to perform URS in 208 out of 215 cases. The overall stonefree rate was 94.6%. 114 patients were primarily stonefree. This was the case in 70.8% of patients with the stone in the distal ureter, in 55.8% in the mid ureter and in 21.3% in the upper ureter. In patients with smaller stones (< 5 mm) 71.5% were primarily stonefree compared to 28.2% in patients with larger stones (> 5 mm). Mean operating time was 32 min (15 - 55 min). Complications were rare with a rate of 13.7%. Severe complications like loss of kidney or disruption of the ureter occurred in 2 patients. Conclusions: URS is a highly efficient method to clear ureteral stones with little complications. It is the method of choice in distal ureteral calculi. In the mid ureter URS seems to be equi-efficient with ESWL. If endoscopic intervention is required for stones in the upper ureter (e.g. because of stone burden or persistent colic pains) immediate URS should be considered. An individualized treatment-concept for ureteral stones especially in the mid and upper ureter is useful.