Objective:
In this study we aimed to compare the rates of complications and stone clearance levels between flexible URS (F-URS) and semi-rigid URS in the treatment of proximal ureteral stones.
Material and Methods:
101 patients who have been operated due to proximal ureteral stones at the urology department of Okmeydanı Training and Research Hospital between 2011 and 2014, were analyzed retrospectively. Each patient received a detailed anamnesis, physical examination, laboratory tests including renal function, urinalysis and urine culture were performed. Urinary tract X-ray, ultrasonography, intravenous urography (IVU) and computed tomography (CT) were performed for imaging purposes. Stone-free was assessed with fluoroscopy, during the operation; with X-ray, at the first postoperative day and with X-ray, ultrasound and CT at the third postoperative month. Absence of any stones at imaging methods or detection of clinically insignificant residual fragments (<4 mm) was considered as successful result. Patients in each group were compared regarding the stone size, success in delivering a stone, operation time, the necessity of re-operation, the stone-free rate in the third month and complications such as fever, bleeding, perforation. Complications were classified according to the Clavien classification system.
Results:
Stone-free rates were found as 64.6% in the group of semirigid URS and 85.2% in group F-URS after surgery (P=0.003). These rates increased to 77.4% and 93,6% respectively, in the third month postoperative radiographic evaluation (p=0.013). Major complications such as sepsis and avulsion were not observed, according to the modified Clavien Classification System (grade 4 or 5). Perforation below the ureteropelvic junction (grade 3B) was seen in 2 patients in group F-URS and conservative treatment with double J catheter placement were done. Postoperative fever (grade 1) was seen in 6 patients (11,1%) in the semirigid URS group and 6 (13,1%) in the F-URS group (p>0.05). Bleeding (grade 1) was observed in 10 patients (20.6%) in the first group and in 5 patients (9.8%) in the second group (p>0.05). Ureteral injury (grade 1) was seen in 4 (7.9%) and 2 (3.2%) patients, respectively (p>0.05).
Conclusion:
F-URS seem to be advantageous with high stone-free rate in the ureterorenoscopic treatment of proximal ureteral stones;. Semirigid URS can also be an alternative treatment modality with a lower success rate.
Keywords: flexible ureterorenoscopy, proximal ureteral stones, semi-rigid ureterorenoscopy