Purpose: To review our 5-year experience with retrograde ureteroscopic treatment for patients with upper ureteral stones and to compare the outcome, safety, and efficiency of pneumatic and holmium laser lithotripsy in managing upper ureteral stones.
Patients and methods: We retrospectively analyzed the hospital records of 372 patients who underwent 384 retrograde ureteroscopic procedures for upper ureteral stones at our center from January 2003 to December 2007. Patient and stone characteristics, treatment variables. and clinical outcomes were assessed. Factors such as failure of the procedure, stone clearance, intraoperative and postoperative morbidity, procedure duration, and hospital stay were analyzed and compared between pneumatic (group 1) and laser lithotripsy (group 2).
Results: Overall, the stone-free rate was 90.4%, the mean operative duration was 41.2 ± 10.7 minutes, the mean postoperative hospital stay was 2.7 ± 0.9 days, and the rates of intraoperative and postoperative complications were 14.6% and 3.9%, respectively, for groups 1 and 2. In comparing group 1 and group 2, the significantly higher number of intraoperative complications coincide with a significantly lower stone-free rate. Nevertheless, the incidence of intraoperative and postoperative complications between the two groups was not statistically significant except in the case of stone upward migration. The mean operative time of group 2 was 43.3 ± 11.1 minutes, which was significantly longer than that for group 1, which was 38.7 ± 9.1 minutes (P < 0.05).
Conclusion: Retrograde ureteroscopy is a safe and effective method for managing upper ureteral stones. A high postoperative stone-free rate is associated with the refined use of a holmium laser lithotriptor to ensure thoroughness while avoiding migration of the stones into the renal pelvis. Although laser lithotripsy has a longer operative time, it remains the more appropriate choice for managing upper ureteral stones.