Ureteroscopy for ureteral stones: Case discussion of impacted stone

Abstract

Technological advances have led to remarkable improvements in the outcomes after ureteroscopy (URS) for ureteral stones. A landmark systematic review and comprehensive analysis of outcomes in 2007 by the American Urological Association (AUA) and European Association of Urology (EAU) showed that URS favorably compares to shock wave lithotripsy (SWL) for all stone locations. URS for distal ureteral stones yielded a 94 % stone-free rate which decreased only slightly to 78-79 % for large (>10 mm), mid, or proximal ureteral stones. After medical expulsive therapy, URS has also been shown to be the most cost-effective therapy for all ureteral stones. Notably, prospective randomized trials comparing shock wave lithotripsy (SWL) to semirigid URS for either proximal or distal ureteral stones showed lower costs and statistically significant higher initial stone-free rates with URS. With a continuous trend towards innovation and improvement of endoscopic devices, one can expect that the efficacy and use of URS for the treatment of ureteral stones will only rise. This chapter provides an outline of the technical approach to URS for ureteral stones. We begin with the importance of preoperative counseling, followed by an overall management algorithm, description of surgical equipment, an intraoperative algorithm, and then finish with the postoperative management and recommended follow-up. At the conclusion of the chapter the treatment of a patient with a large impacted proximal ureteral stone will be discussed.