Clinical outcome of ureteroscopic lithotripsy for 2,129 patients with ureteral stones

摘要

The objective of this study was to retrospectively analyze the clinical outcomes of ureteroscopic lithotripsy (USL) performed in patients with ureteral stones, and to investigate the factors associated with therapeutic outcomes. This study included a total of 2,129 patients with ureteral stones who underwent USL between December 1985 and March 2006 in a single institution in Japan. In this series, ultrasonic lithotripsy was primarily performed, and forceps and/or baskets were occasionally used for the removal of stones. Complete removal was defined as total clearance 1 day after the initial USL. The initial stone-free rate following a single treatment with USL was 73.3%. Of 569 patients diagnosed as having fragmentation of residual stones, additional therapy was not performed for 115 with stones likely to pass spontaneously, while the remaining 454 subsequently underwent extracorporeal shock wave lithotripsy. Thereafter, ureterolithotomy or percutaneous nephrolithotripsy was further added in 14. Ureteral perforation occurred in 14 patients, of whom 2 underwent nephrectomy; however, there were no other serious complications that could not be managed by conservative treatment. Whether ureteral stones were completely removed by an initial USL was significantly associated with the history of ureteral stone, severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones. Furthermore, multivariate analysis identified the severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones as independent predictors for complete removal of ureteral stones by the initial USL application. These findings suggest that USL could be a safe and effective treatment option for ureteral stones; however, other therapeutic strategies should also be considered in patients with currently identified risk factors associated with treatment failure following a single USL procedure.