Retrograde endoscopic management of ureteral stones more than 2 cm in size

ObjectivesTo verify the safety and efficacy of retrograde endoscopic lithotripsy as the treatment modality for large ureteral stones.MethodsFrom July 1996 to May 2005, we performed retrograde endoscopic treatment in 54 patients with large ureteral stones more than 2 cm in size, using a small-caliber ureteroscope and a holmium:yttrium-aluminum-garnet laser lithotriptor. Although the mean maximal stone diameter was 2.4 cm, 6 patients had stones measuring larger than 3 cm. Of the 54 patients, 11 had stones that could not be effectively fragmented by shock wave lithotripsy previously.ResultsOf the 54 patients, 48 were treated solely using retrograde ureteroscopy. In 47 patients (87%), the stones were fragmented completely by a single endoscopic procedure. Additional shock wave lithotripsy was performed after endoscopic debulking in 2 patients, and any stones remaining in the ureter were easily treated by shock wave lithotripsy. Pyelonephritis resulting from obstruction caused by ureteral stones was observed in 4 patients, 3 of whom required percutaneous nephrostomy and 1 of whom required stent insertion before the endoscopic procedure. These patients then underwent retrograde endoscopic lithotripsy, which completely cleared the calculi in one session. No intraoperative complications occurred. The only postoperative complication was found in 1 patient presenting with a ureteral stricture. One month after the final treatment, no patients had evidence of residual stones.ConclusionsWith use of a small-caliber ureteroscope and a holmium:yttrium-aluminum-garnet laser lithotriptor, retrograde endoscopic lithotripsy seems to be an effective first-line therapy for large ureteral stones measuring more than 2 cm in size.