Efficiency of contact ureterolithotripsy in treatment of proximal ureteral large stones

Introduction. Currently, indications for intracorporeal lithotripsy of ureteral stones with sizes up to 10 mm inclusively of different localization are established. However, there is no consensus was reached on the preferences of this type of surgery over other existing one in the case of proximal ureteral obstruction by a stones greater than 10 mm in size. Endoscopic ureterolithotripsy is associated with existing studies on the effectiveness and safety of this method. Thus, it is important to continue conducting comparative studies in this direction.

Materials and methods. 54 patients with proximal ureteral stones larger than 10 mm in size were investigated. All patients underwent Semi-Rigid Ureteroscopy and Laser Lithotripsy (SRULL) using a semi-rigid ureteroscope. Patients was stratified into several groups in accordance with the size of stones according to the actual AUA classification: group A (n - 46), the dimensions of ureteral stones from 11 to 20 mm inclusive and group B (n - 8), the size of stones over 20 mm. Criterion for the effectiveness of treatment was to achieve the "Stone Free" level after performing lithotripsy. Indicator of treatment failure was the impossibility of complete removal of ureteral stone within one surgical procedure without its expansion. Statistical data processing was performed using non-parametric data analysis methods applying the STATISTICA 10 (StatSoft Inc., USA) software package.

Results. Larger stones compared to higher density. Obstruction symptoms such as hydronephrosis, nausea and vomiting, gross hematuria were more common with stones > 20 mm. Treatment duration in patient groups is similar despite differences in the number of complications and the incidence of postoperative ureteral stenting. At the same time, operation time depended on stone size and density. Surgery efficacy in patient groups was comparable and met 78.3% in group A versus 75.0% in group B.

Conclusion. Inflammatory and destructive changes in the ureter wall are more common with stones greater than 20 mm, which affects the incidence of postoperative complications. Increasing the operation duration and frequency of proximal fragments' migration are determined by increasing of the stones' size and density. SRULL important feature is the lack of statistical difference in the effectiveness with the different sizes of stones. In addition, the achievement of "Stone Free" level for various size's stones does not exceed one day. Performing a SRULL of proximal ureter's large stones on the first day of a patient's hospitalization is accompanied by greater treatment efficacy. It statistically reliably determines the reduction in the frequency of postoperative complications.

1. Kaprin AD, Apolikhin OI, Sivkov AV, Solntseva TV, Komarova VA. Analysis of uronephrological morbidity and mortality in Russian Federati on for 2003-2013. Experimental and clinical urology. 2016; 3: 4-13. (In Russ.). eLIBRARY ID: 28870098

2. Kirkali Z, Rasooly R, Star R, Rodgers G. Urinary Stone Disease: Progress, Status, and Needs. Urology. 2015; 86(4): 651-653. DOI: 10.1016/j.urology.2015.07.006

3. Bourdoumis A, Papatsoris A, Calleary J, Surange R, Skrepetis K, Buchholz N, Sarica K. The evolution of urolithiasis assessment and management in the new millennium. Panminerva Med. 2016; 58(3): 222-236. PMID:27074421

4. Lopatkin NA, Martov AG. Occlusion factor in the development of urolithiasis complications. Urology. 1999; 1: 47-51. (In Russ.)

5. Fuchs G. Complications of stone disease in the 21st century-can noninvasive and minimally invasive treatment modalities improve the overall renal health of stone formers? J Urol. 2014; 192(5): 1322-1323. DOI: 10.1016/j.juro.2014.08.048

6. Muslumanoglu AY, Karadag MA, Tefekli AH, Altunrende F, Tok A, Berberoglu Y. When is open ureterolithotomy indicated for the treatment of ureteral stones? Int J Urol. 2006; 13: 1385-1388. DOI: 10,1111/j.1442-2042.2006.01585.x

7. Matlaga B, Krambeck A, Lingeman J. Surgical Management of Upper Urinary Tract Calculi. In: Wein A.J., Kavoussi L.R., Partin A.W., Peters C.A. Campbell-Walsh Urology. Eleventh Edition. Elsevier Inc; 2016. p. 1260-1287.

8. Lee Y, Tsai J, Jiaan B, Wu T, Yu C. Prospective randomized trial comparing shock wave lithotripsy and ureteroscopic lithotripsy for management of large upper third ureteral stones. Urology. 2006; 67: 480-484. DOI: 10.1016/j.urology.2005.09.067

9. Moufid K, Abbaka N, Touiti D, Adermouch L, Amine M, Lezrek M. Large impacted upper ureteral calculi: A comparative study between retrograde ureterolithotripsy and percutaneous antegrade ureterolithotripsy in the modified lateral position. Urol Ann. 2013; 5: 140-146. DOI: 10,4103/0974-7796.115729

10. Zhu H, Ye X, Xiao X, Chen X, Zhang Q, Wang H. Retrograde, antegrade and laparoscopic approaches to the management of large upper ureteral stones after shockwave lithotripsy failure: A four-year retrospective study. J Endourol. 2014; 28: 100-103. DOI: 10.1089/end.2013.0391

11. Bozkurt I, Yonguc T, Arslan B, Degirmenci T, Gunlusoy B, Aydogdu O, Koras O. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy? Can Urol Assoc J. 2015; 9(3-4): E122-125. DOI: 10,5489/cuaj.2280

12. Wu T, Duan X, Chen S, Yang X, Tang T, Cui S. Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones: A Systematic Review and Meta-Analysis. Urol Int. 2017; 99(3): 308-319. DOI: 10,1159/000471773

13. Wang Q, Guo J, Hu H, Lu Y, Zhang J, Qin B, Wang Y, Zhang Z, Wang S. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A metaanalysis. PLoS One. 2017; 12(2): e0171478. DOI: 10,1371/journal.pone.0171478

14. Turk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K. Guidelines Associates: J.F. Donaldson, T. Drake, N. Grivas, Y. RuhayelEuropean Association of Urology. Guidelines on Urolithiasis. 2018 [internet publication]. http://uroweb.org/guideline/urolithiasis.

15. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016; 196(4): 1153-1160. DOI: 10,1016/j.juro.2016.05.090

16. Scott J, Huskisson E. Graphic representation of pain. Pain 1976; 2 (2): 175-184. PMID: 1026900

17. Williamson A., Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005; 14(7): 798-804. DOI: 10,1111/j.1365-2702.2005.01121.x

18. Hwan VK, Trusov PV. Influence of duration of upper urinary tract calculi obstructi on on the efficiency of laser contact ureterolithotripsy Experimental and clinical urology. 2014; 3: 40-43. (In Russ.). eLIBRARY ID: 22593064

19. Al-Ghazo M, Ghalayini I, Al-Azab R, Bani Hani O, Bani-Hani I, Abuharfil M, Haddad Y. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study. Urol Res. 2011; 39: 497-501. DOI: 10.1007/s00240-011-0381-y

20. Picozzi S, Ricci C, Gaeta M, Casellato S, Stubinski R, Bozzini G, Pace G, Macchi A, Carmignani L. Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients. Urol Res. 2012; (40)5: 581-586. DOI: 10.1007/s00240-012-0469-z

21. Sarica K, Tanriverdi O, Aydin M, Koyuncu H, Miroglu C. Emergency ureteroscopic removal of ureteral calculi after first colic attack: is there any advantage? Urology. 2011; 78: 516-520. DOI: 10.1016/j.urology.2011.01.070

22. Sarica K, Yryildirim B, Sahin C, Turkoglu O, Tuncer M, Coskun A, Akdere H. Emergency management of ureteral stones: Evaluation of two different approaches with an emphasis on patients' life quality. Arch Ital Urol Androl. 2016; 88(3): 201205.

23. Tran T, Hernandez Bustos N, Kambadakone A, Eisner B, Pareek G. Emergency ureteral stone treatment score predicts outcomes of ureteroscopic intervention in acute obstructive uropathy secondary to urolithiasis. J Endourol. 2017; 31(9): 829-834 DOI: 10.1089/end.2017.0043