Ureteroscopic removal of mid and proximal ureteral calculi

Purpose: Extracorporeal shock wave lithotripsy (ESWL dagger) is considered standard therapy for most renal calculi as well as more than 80% of all upper urinary tract stones. The development of flexible and small diameter rigid ureteroscopes, and the increased availability of laser lithotriptors have made endoscopic treatment of ureteral calculi more successful and safe. This report represents our contemporary series of 80 single mid and proximal ureteral calculi treated endoscopically. Materials and Methods: A total of 78 patients underwent 80 primary endoscopic procedures with 3 auxiliary ESWL and 2 endoscopic re-treatments for 41 mid and 39 proximal ureteral calculi. Lithotripsy was performed for 55 of the 80 stones. Results: Of the 80 stones 75 (94%) successfully cleared 1 month after 1 endoscopic procedure. The success rate was 38 of 39 (97%) for proximal calculi and 37 of 41 (90%) for mid ureteral stones. With a single re-treatment overall success increased to 96%. If adjuvant ESWL was added, 100% success was attained. Currently all procedures are performed on an outpatient basis. Morbidity is low and there have been no major complications, such as stricture, renal loss or death. Conclusions: Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of mid and proximal ureteral calculi. Thus, ureteroscopic treatment should be considered a treatment of choice for upper ureteral calculi.