Original Paper
Urologia Internationalis
Received: May 5, 2014 Accepted after revision: June 25, 2014 Published online: August 23, 2014
Urol Int 2015;94:166–172 DOI: 10.1159/000365521
Does a Retrograde Pyelography prior to Ureteroscopy Influence Stone-Free Rates and Complication Rates in Ureteral Calculi? Stephan Seklehner Ortwin Heißler Paul F. Engelhardt Claus Riedl Landesklinikum Baden-Mödling, Department of Urology, Baden, Austria
Key Words Ureteral calculi · Ureteroscopy · Surgical procedures · Minimally invasive · Urography
Abstract Objectives: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. Methods: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. Results: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p = 0.0001). Partial stone removal rates were similar in both groups (p = 0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p = 0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p = 0.007) and the proximal ureter (14.5 vs. 38.6%, p = 0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71–5.43, p < 0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22–0.61, p < 0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p = 0.65). Conclusions: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS. © 2014 S. Karger AG, Basel
© 2014 S. Karger AG, Basel 0042–1138/14/0942–0166$39.50/0 E-Mail [email protected] www.karger.com/uin
Introduction
Calculi of the upper urinary tract are a common condition, affecting several millions worldwide. Epidemiological studies showed a 4.7% self-reported prevalence of upper urinary tract calculi in Germany and 8.8% in the United States [1, 2]. Active removal of ureteral calculi is indicated in stones with a low likelihood of spontaneous passage, persistent pain despite adequate analgesia, persistent obstruction of the upper urinary tract, infection, and renal insufficiency [3–6]. Ureteroscopy (URS) is the treatment modality mostly used for ureteral calculi removal and further expands at the expense of extracorporeal shock-wave lithotripsy and ureterolithotomy [7]. Currently, URS is the treatment option of first choice for calculi of any size in the distal ureter, for those >10 mm in the proximal ureter and a second choice modality for proximal calculi sized
Urologia Internationalis
Received: May 5, 2014 Accepted after revision: June 25, 2014 Published online: August 23, 2014
Urol Int 2015;94:166–172 DOI: 10.1159/000365521
Does a Retrograde Pyelography prior to Ureteroscopy Influence Stone-Free Rates and Complication Rates in Ureteral Calculi? Stephan Seklehner Ortwin Heißler Paul F. Engelhardt Claus Riedl Landesklinikum Baden-Mödling, Department of Urology, Baden, Austria
Key Words Ureteral calculi · Ureteroscopy · Surgical procedures · Minimally invasive · Urography
Abstract Objectives: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. Methods: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. Results: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p = 0.0001). Partial stone removal rates were similar in both groups (p = 0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p = 0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p = 0.007) and the proximal ureter (14.5 vs. 38.6%, p = 0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71–5.43, p < 0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22–0.61, p < 0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p = 0.65). Conclusions: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS. © 2014 S. Karger AG, Basel
© 2014 S. Karger AG, Basel 0042–1138/14/0942–0166$39.50/0 E-Mail [email protected] www.karger.com/uin
Introduction
Calculi of the upper urinary tract are a common condition, affecting several millions worldwide. Epidemiological studies showed a 4.7% self-reported prevalence of upper urinary tract calculi in Germany and 8.8% in the United States [1, 2]. Active removal of ureteral calculi is indicated in stones with a low likelihood of spontaneous passage, persistent pain despite adequate analgesia, persistent obstruction of the upper urinary tract, infection, and renal insufficiency [3–6]. Ureteroscopy (URS) is the treatment modality mostly used for ureteral calculi removal and further expands at the expense of extracorporeal shock-wave lithotripsy and ureterolithotomy [7]. Currently, URS is the treatment option of first choice for calculi of any size in the distal ureter, for those >10 mm in the proximal ureter and a second choice modality for proximal calculi sized
