Where is it logical to break-up a ureter stone with endoscopic surgery?
Keywords:Ureter Stone, Push-up, Stone Migration, Antiretropulsion, Flexible Ureterorenoscopy, Rigid Ureteroscopy
Background/Aim: Today, we have the technology to break up a ureter stone in the ureter, as well as in the renal pelvis, with ureterorenoscopic procedures. In the past, when this option was not available, the surgeons improved several techniques and antiretropulsion devices to let the stone migrate through the renal pelvis. This study was conducted to clarify whether it is more advantageous to dust a stone in the ureter where it is impacted or in a wider area such as the renal pelvis. Methods: The data of 134 patients who underwent semirigid ureterorenoscopy (srURS) due to single and primary upper ureteral stones were included and analyzed in this retrospective cohort study. The patients were divided into two groups according to the development of spontaneous push-up during surgery (Group 1: The non-push-up group, Group 2: The push-up group). Results: While hemoglobin levels lowered significantly in both groups after the surgery, creatinine levels increased (P<0.05). However, there was no significant difference between the groups regarding preoperative or postoperative laboratory findings (P>0.05). Operation times were similar in both groups, in contrast with the literature. Stone-free rates were significantly higher in srURS than in intrarenal surgery (RIRS) (P=0.03). Complication rates were also similar in this study. Conclusion: The application of srURS after fixing an upper ureter stone at its location using a Stone Cone® results in higher stone-free rates than pushing it back to dust it in renal pelvis. We recommend srURS supported by an antiretropulsion method as a treatment for upper ureteral stones.
Shah TT, Gao C, Peters M, Manning T, Cashman S, Nambiar A, et al. Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multi-centre cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. BJU Int. 2019;124:504–13.
Akkoç A, Uçar M. Can rigid ureteroscopic lithotripsy be an alternative to flexible ureteroscopic lithotripsy in the treatment of isolated renal pelvis stones smaller than 2 cm? J Surg Med. 2020;4:305–8. doi: 10.28982/JOSAM.722331.
Yencilek F, Sarica K, Erturhan S, Yagci F, Erbagci A. Treatment of ureteral calculi with semirigid ureteroscopy: Where should we stop? Urol Int. 2010;84:260–4. doi: 10.1159/000288225.
Kartal I, Yalçınkaya F, Baylan B, Cakıcı MC, Sarı S, Selmi V, et al. Comparison of semirigid ureteroscopy, flexible ureteroscopy, and shock wave lithotripsy for initial treatment of 11-20 mm proximal ureteral stones. Arch Ital di Urol e Androl. 2020;92:39–44. doi: 10.4081/aiua.2020.1.39.
Galal EM, Anwar AZ, Fath El-Bab TK, Abdelhamid AM. Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones. Int Braz J Urol. 2016;42:967–72. doi: 10.1590/S1677-5538.IBJU.2015.0644.
Zhou R, Han C, Hao L, Chen B, Zang G, Fan T, et al. Ureteroscopic lithotripsy in the Trendelenburg position for extracting obstructive upper ureteral obstruction stones: a prospective, randomized, comparative trial. Scand J Urol. 2018;52:291–5. doi: 10.1080/21681805.2018.1492966.
Saussine C, Andonian S, Pacík D, Popiolek M, Celia A, Buchholz N, et al. Worldwide Use of Antiretropulsive Techniques: Observations from the Clinical Research Office of the Endourological Society Ureteroscopy Global Study. J Endourol. 2018;32:297–303. doi: 10.1089/end.2017.0629.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004;240:205–13.
Sun Y, Wang L, Liao G, Xu C, Gao X, Yang Q, et al. Pneumatic lithotripsy versus laser lithotripsy in the endoscopic treatment of ureteral calculi. In: Journal of Endourology. Mary Ann Liebert Inc.; 2001. p. 587–90. doi: 10.1089/089277901750426346.
Knispel HH, Klän R, Heicappell R, Miller K. Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: Results in 143 patients. J Endourol. 1998;12:513–5. doi: 10.1089/end.1998.12.513.
Patel RM, Walia AS, Grohs E, Okhunov Z, Landman J, Clayman R V. Effect of positioning on ureteric stone retropulsion: ‘gravity works.’ BJU Int. 2019;123:113–7. doi: 10.1111/bju.14510.
Zehri AA, Ather MH, Siddiqui KM, Sulaiman MN. A Randomized Clinical Trial of Lidocaine Jelly for Prevention of Inadvertent Retrograde Stone Migration During Pneumatic Lithotripsy of Ureteral Stone. J Urol. 2008;180:966–8. doi: 10.1016/j.juro.2008.05.008.
Dretler SP. Ureteroscopy for proximal ureteral calculi: Prevention of stone migration. J Endourol. 2000;14:565–7. doi: 10.1089/08927790050152159.
Dretler SP. The stone cone: A new generation of basketry. J Urol. 2001;165 5 I:1593–6.
Wang CJ, Huang SW, Chang CH. Randomized trial of NTrap for proximal ureteral stones. Urology. 2011;77:553–7. doi: 10.1016/j.urology.2010.07.497.
Mirabile G, Phillips CK, Edelstein A, Romano A, Okhunov ZN, Hruby GW, et al. Evaluation of a novel temperature-sensitive polymer for temporary ureteral occlusion. In: Journal of Endourology. J Endourol; 2008. p. 2357–9. doi: 10.1089/end.2008.0029.
Gonen M, Cenker A, Istanbulluoglu O, Ozkardes H. Efficacy of Dretler Stone Cone in the treatment of ureteral stones with pneumatic lithotripsy. Urol Int. 2006;76:159–62.
Sen H, Bayrak O, Erturhan S, Urgun G, Kul S, Erbagci A, et al. Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy. Urol Int. 2014;92:334–8. doi: 10.1159/000351002.
Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61:713–8. doi: 10.1016/S0090-4295(02)02440-8.
Auge BK, Pietrow PK, Lallas CD, Raj G V., Santa-Cruz RW, Preminger GM. Ureteral Access Sheath Provides Protection against Elevated Renal Pressures during Routine Flexible Ureteroscopic Stone Manipulation. J Endourol. 2004;18:33–6. doi: 10.1089/089277904322836631.
Yang B, Ning H, Liu Z, Zhang Y, Yu C, Zhang X, et al. Safety and efficacy of flexible ureteroscopy in combination with holmium laser lithotripsy for the treatment of bilateral upper urinary tract calculi. Urol Int. 2017;98:418–24. doi: 10.1159/000464141.
Öztekin Ü, Erkoç F, Sarı S, Selmi V, Gürel A, Ataç F. The effect of ureterorenoscopy and retrograde intrarenal surgery procedures on renovascular hemodynamics. Ann Clin Anal Med. 2020;11:272–6. doi: 10.4328/acam.20066.
Karadag MA, Demir A, Cecen K, Bagcioglu M, Kocaaslan R, Sofikerim M, et al. Flexible ureterorenoscopy versus semirigid ureteroscopy for the treatment of proximal ureteral Stones: A retrospective comparative analysis of 124 patients. Urol J. 2013;11:1867–72.
Özkaya F, Sertkaya Z, Karabulut I, Aksoy Y. The effect of using ureteral access sheath for treatment of impacted ureteral stones at mid-upper part with flexible ureterorenoscopy: A randomized prospective study. Minerva Urol e Nefrol. 2019;71:413–20. doi: 10.23736/S0393-2249.19.03356-3.
Cabrera FJ, Preminger GM, Lipkin ME. Antiretropulsion devices. Current Opinion in Urology. 2014;24:173–8. doi: 10.1097/MOU.0000000000000032.
Pan J, Xue W, Xia L, Zhong H, Zhu Y, Du Z, et al. Ureteroscopic lithotripsy in Trendelenburg position for proximal ureteral calculi: A prospective, randomized, comparative study. Int Urol Nephrol. 2014;46:1895–901. doi: 10.1007/s11255-014-0732-z.
Xu C, Song RJ, Jiang MJ, Qin C, Wang XL, Zhang W. Flexible ureteroscopy with holmium laser lithotripsy: A new choice for intrarenal stone patients. Urol Int. 2015;94:93–8. doi: 10.1159/000365578.
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