Difficulties and countermeasures in retrograde ureteroscopy for proximal ureteral calculi without a pre-set stent

doi:10.3877/cma.j.issn.1674-0785.2024.09.001

Abstract

Abstract:

Objective

To improve the treatment success rate of retrograde ureteroscopy in patients with proximal ureteral stones without a preset stent during a single hospitalization.

Methods

A coping path was developed for the difficulties encountered in semi-rigid ureteroscopy （sURS） surgery， and the data of 148 patients （156 sides） with proximal ureteral calculi who met the inclusion criteria and underwent the surgery according to the coping path between 2022 and 2023 were reviewed.

Results

Of the 148 patients included，143 （96.6%） completed the first stage treatment and 5 （3.4%） completed the second stage treatment. Two（1.4%） patients had fever 24 hours after operation， but there was no sepsis or Traxer grade 4 ureteral injury.No hydronephrosis was observed during a follow-up period of 6 to 12 months. In this study， patients with proximal ureteral stones without a preset stent had a 73.7% success rate of initial 8/9.8 Fr sURS placement.This rate improved to 82.1% after coaxial dilatation. Switching to ultrafine （4.5/6.5 Fr） sURS still prevented access to stones due to difficulty in ascending in 9.6% of cases.

Conclusion

With the awareness of multilink "ureteral mucosal protection"， the path to cope with difficult ureteral calculi through a combination of techniques is effective and safe， and can help complete the treatment of patients within a single hospitalization to the greatest extent.

Key words: Slender ureter, Difficult ureter, Ureteroscopy, Proximal ureteral calculi

Ying Ni, Tielong Zhang, Gang Wang, Yulong Gao, Shaopeng Chen, Jiaxuan Ni. Difficulties and countermeasures in retrograde ureteroscopy for proximal ureteral calculi without a pre-set stent[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(09): 795-801.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2024.09.001

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References 18

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