Garduño-Arteaga L, Castell-Cancino R, Virgen-Gutierrez JF, Jaspersen-Gastelum J, Rosas-Nava JE

Language: Spanish
References: 23
Page: 325-330
PDF size: 427.33 Kb.

ABSTRACT

Introduction: Ureteroscopy has been widely used as a diagnostic method and as treatment of supravesical urinary tract disease.
Objective: To carry out a review of management experience of ureteral lithiasis patients by means of rigid ureteroscopy from 1988-2008 in the Urology Department of the Hospital General de México.
Methods: An observational, comparative, retrospective study was carried out that included 1088 patients diagnosed with ureteral lithiasis that underwent ureteroscopy at the Urology Department of the Hospital General de México from January 1, 1988 to December 31, 2008.
Results: A total of 1088 case records of patients diagnosed with ureteral lithiasis that underwent ureteroscopy were analyzed. Of that total, 691 (63.5%) were men and 397 (36.5%) were women. There were 555 (51%) right ureteroscopies, 467 (42.93%) left ureteroscopies, and 66 (6.07%) bilateral procedures. Patient age ranged from 7-82 years. Location was divided into three ureteral segments: 925 patients (85%) had stones in the lower segment, 108 (10%) had stones in the middle segment, 49 (4.5%) in the upper segment, and 6 patients (0.5%) had stones in multiple locations. In regard to stone size, 327 patients (30%) had stones under 5 mm, 436 patients (40%) had stones from 5.1-10 mm, 217 (20%) had stones from11-15 mm, 76 (7%) from 16-20 mm, and 32 patients (3.5%) had stones larger than 20 mm. Different equipment was used for fragmentation: 747 (68.7%) procedures were performed with pneumatic lithotripsy, 58 (5.3%) with electrohydraulic lithotripsy, 21 (1.9%) with ultrasound lithotripsy, and 262 (24.1%) only with lapaxy. Double-J ureteral catheter was placed in 914 patients (84%) after procedure. No catheter was placed in the remaining 174 patients (16%). There was an 87% (947) success rate in patients. Procedure failure in the remaining 141 patients (13%) was due to stone migration that was managed with extracorporeal lithotripsy in 76 patients (7%), and double-J ureteral catheter was placed in the 65 patients (6%) in whom advancement was impossible. Complications presented in 38 patients (3.49%): false route in 17 patients (1.56%), ureteral perforation in 12 patients (1.1%), ureteral stricture in 5 patients (0.45%), acute abdomen in 2 patients (0.18%), hemorrhage in 1 patient (0.09%), and ureteral avulsion in 1 patient (0.09%). These complications were managed with double-J ureteral catheter placement. Exploratory laparotomy and ureteral implant were carried out in the patient that presented with ureteral avulsion.
Conclusions: Semi-rigid ureteroscopy is a safe, fast, and effective procedure for managing ureteral lithiasis in the different segments. Success rates and complication rates in the present study were similar to those reported in the international literature.

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