Flexible Ureteroscopy is Effective for Proximal Ureteral Stones in Both Obese and Nonobese Patients: A Two-year, Single-surgeon Experience

ObjectiveTo report a retrospective series of proximal ureteral stone ureteroscopies (URS) by a single surgeon, using results presented in a recommended format from the American Urological Association Ureteral Stone Guideline panel, with an emphasis on outcomes related to obesity.MethodsA retrospective chart review of a single surgeon's 2-year URS experience was performed. Of the 55 ureteroscopies for proximal ureteral calculi, 49 cases involving 43 patients had evaluable postoperative imaging.ResultsMean patient age was 56 years and average body mass index was 32.5 kg/m2. Average ureteral stone size was 9.1 mm; 51% had been preoperatively stented and 93% were stented postoperatively. The overall ureteral stone–free rate was 86%. Overall, 5/43 patients (11%), none of whom were obese, required a second procedure. Obese patients had a 91% stone-free rate, statistically equivalent to the 81% rate in the nonobese. Three patients (7%) developed postoperative urinary tract infections. One patient came to the emergency department for stent-related discomfort. One patient treated in a staged setting for bilateral ureteral calculi developed urinary tract infection and systemic inflammatory response system complicated by alcohol withdrawal requiring a 3-day non–intensive care unit admission.ConclusionsProximal ureteral calculi can be successfully treated with URS most of the time, but the risk for persistent renal calculi and fragments exists. The complication rate is low and operative times are short. Obese patients can also be successfully treated ureteroscopically.