Efficacy and safety of semi-rigid ureteroscopic lithotripsy (URS) for proximal ureteral stone =10 mm

Objective: To evaluate the efficacy and safety of the semi-rigid URS with pneumatic lithotripsy for the treatment of large (≥10 mm) proximal ureteral calculi. Study Design: Cohort study. Place and Duration of Study: Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from January 2010 to December 2018. Methodology: All patients with single, radio-opaque unilateral proximal ureteral stones ≥10 mm were included in the study. Patients with urosepsis, pregnancy, solitary kidney, and indwelling JJ stent or prior percutaneous nephrostomy drainage were excluded. Patients without any visualisation of stone on abdominal X-Ray done at 4 weeks of the procedure were labelled as stone-free. Results: One hundred and three cases with stones ≥10 mm and fulfilling the selection criteria were included. The mean age was 40.83 ± 14.92 years. The mean stones size was 13.33 ± 4.64 mm. The mean procedure time was 41.50 ± 15.60 minutes. Indwelling JJ stents were placed in 49 (47.6 %) cases. The stone-free rate was 83.5% at four weeks with calculated efficiency quotient (EQ) of 0.72, using a standard equation. The overall complication rate was 27% with the majority being minor (Clavian- Dindo grade 1). Only one patient had urosepsis (MCG IV). Ancillary procedures were performed in 17 (16.5%) cases, most commonly the extracorporeal shock wave lithotripsy (ESWL) in 14 (13.5%) cases, followed by the secondary URS in 3 (2.9%) cases. Conclusion: Semi-rigid URS is an effective and safe procedure for the large proximal ureteral stones, with limited access to flexible instruments.