Flexible Ureteroscopy May Be Suitable for Proximal Ureteral Stones

It achieved a stone-free rate of 95% in patients with stones smaller than 2 cm.
It achieved a stone-free rate of 95% in patients with stones smaller than 2 cm.

ORLANDO—Flexible ureteroscopy to remove proximal ureteral stones smaller than 2 cm is associated with excellent clinical outcomes, researchers reported at the American Urological Association 2014 annual meeting.

The procedure achieves a stone-free rate that compares favorably with shock wave lithotripsy, according to the investigators, who noted that the optimal management for proximal ureteral stones remains unclear.

In a prospective study, Elias S. Hyams, MD, Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues examined the efficacy and safety of flexible ureteroscopy in 69 adult patients (mean age 48.6 years, range 28-82 years) with proximal ureteral stones less than 2 cm in diameter.

Patients had a mean stone size of 7.4 mm. The mean surgical time was 60.3 minutes. The procedure achieved a stone-free rate of 95%. Intraoperative complications occurred in 2 patients (2.8%) and postoperative complications occurred in 6 (8.7%).

Dr. Hyams pointed out that 2007 AUA guidelines cited a lack of adequate data to recommend ureteroscopy or shock wave lithotripsy for the treatment of proximal ureteral stones, so the 2 modalities were  considered to be equivalent treatment options.

“We demonstrated that the procedure was safe, not surprisingly, with a very low rate of morbidity, and the stone free rate was extremely high at 95%,” Dr. Hyams said. “We do hope that these are benchmark data that can be used in discussions for treatment guidelines in the future.”

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