Vol. 6, Issue 1, Part B (2024)

Background: Ureteroscopy (URS) is a precise, minimally invasive surgical intervention that can assess the entire collecting system to treat a stone using intracorporeal lithotripsy. The implication of laser technology in the development of lithotripter fibres has revolutionized intracorporeal lithotripsy.

Objectives: The impact and the outcome of holmium: YAG-laser ureterolithotripsy in treating proximal and distal ureteric stones were investigated.

Methods: A total of 100 patients harboring proximal (n=64) and distal (n=36) ureteral stones underwent semirigid Ho ureterolithotripsy. The degree of hydronephrosis, stone size, location, impaction, and complication and stone-free rates were recorded.

Results: The mean stone size for proximal and distal stones was 7.1 ± 3.6 mm and 6.2 ± 2.5 mm, respectively. The stone-free rates on the first postoperative day were 77.7% (28/36) for proximal and 95.3% (62/64) for distal stones (p< 0.0001). For proximal stones <10 mm and ≥10 mm, the stone-free rate was 80.5% (22/28) and 74.3% (6/8) (p=0.4), and for distal stones, it was 97.3% (58/60) and 94.3% (4/6) (p=0.2). Stone-free rates for radio-opaque versus radiolucent stones in proximal stones were 79.6% (23/30) versus 77.9% (4/6) (p=0.8), and 97.6% (58/64) versus 96.2% (8/64) in distal stones (p=0.5). Impaction correlated significantly with stone-free rates (p< 0.0001). Stone-free rates for non-impacted versus impacted proximal stones were 83.3% (20/24) versus 66.6% (8/11) (p=0.003), and for distal stones, they were 97.6% (44/45) versus 89.4% (17/19) (p<0.003), respectively. The presence or degree of hydronephrosis did not correlate with treatment success (p=0.4, p=0.8). The presence of intraoperative complications correlated significantly with proximal compared to distal ureteral stone location (p=0.004). Auxiliary measures in proximal versus distal stones were performed in 19.3% (6/31) versus 3.2% (2/64) (p<0.001).