A stone pushed back to the collecting system – long therapeutic path in centers with limited access to flexible instruments

摘要

Introduction Availability of flexible ureteroscopes is still limited in many countries and centers. Under suchcircumstances treating small stones pushed from the ureter to the kidney that pose a risk of symptomaticrecurrence is controversial as it may require a number of surgical procedures to remove. The aim of thisstudy was to assess the type and number of procedures used to treat stones relocated from the ureterto the collecting system in a high volume urological center with limited access to flexible instruments.Materials and methods Patients treated for ureteral stones in years 2013–2016 were retrospectivelyreviewed. All procedures performed after stone relocation were counted. Final stone status was determinedby ultrasonography and radiography.Results Out of 75 patients with a stone relocated to the collecting system full follow-up was availablefor 66. In three patients (4%) the stone remained in the collecting system untreated. Seven patients(11%) passed their stones spontaneously. Active treatment was successful in 45 (68%), while it failedin 11 (17%) patients. Extracorporeal shock wave lithotripsy was used 132 times, semi-rigid ureteroscopy21 times and percutaneous nephrolithotripsy 22 times – 175 procedures altogether (2.6 procedures/patient + accessory procedures such as JJ removal). Shockwave lithotripsy was effective in 7/41patients, semi-rigid ureteroscopy in 18/21 and percutaneous nephrolithotripsy in 22/22 patients.Conclusions Treating small stones relocated from the ureter to the collecting system in centers notequipped with flexible endoscopes is inefficient, time-consuming or too invasive. Cost-effectivenessanalysis should follow this study to obtain evidence for public health payers to change their policies.