Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations: The Clinical Research Office of the Endourological Society Ureteroscopy Global Study

Abstract

Background: Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones. Objective: To describe the differences in the treatment and outcomes of ureteroscopic stones in different locations. Design, setting, and participants: Prospective data were collected by the Clinical Research Office of the Endourological Society on consecutive patients treated with ureteroscopy at centres around the world over a 1-yr period. Intervention: Ureteroscopy was performed according to study protocol and local clinical practice guidelines. Outcome measurements and statistical analysis: Stone location, treatment details, postoperative outcomes, and complications were recorded. Pearson's chi-square analysis and analysis of variance were used to compare outcomes among the different stone locations. Results and limitations: Between January 2010 and October 2012, 9681 patients received ureteroscopy treatment for stones located in the proximal ureter (n = 2656), midureter (n = 1980), distal ureter (n = 4479), ormultiplelocations (n = 440); locationin126patientswasnot specified. Semirigid ureteroscopy was predominantly used for all stone locations. Laser and pneumatic lithotripsy were used in the majority of cases. Stone-free rates were 94.2% for distal ureter locations, 89.4% for midureter locations, 84.5% for proximal ureter locations, and 76.6% for multiple locations. For the proximal ureter, failure and retreatment rates were significantly higher for semirigid ureteroscopy than for flexible ureteroscopy. A low incidence of intraoperative complications was reported (3.8-7.7%). Postoperative complications occurred in 2.5-4.6% of patients and varied according to location, with the highest incidence reported for multiple stone locations. Limitations include shortterm follow-up and a nonuniform treatment approach. Conclusions: Ureteroscopy for ureteral stones resulted in good stone-free rates with low morbidity. Patient summary: This study shows that patients who have ureteral stones can be treated successfully with ureteroscopy with a low rate of complications for the patient. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.