Retrograde Ureteroscopy with Pneumatic Lithotripsy in the Treatment of Proximal Ureteric Stones: A Retrospective Analysis of Outcomes and Complications

ABSTRACT Background: Proximal ureteric stones present peculiar management challenges. Objective: This study seeks to audit the outcomes and complications of using semirigid ureteroscopy with pneumatic lithotripsy for the treatment of proximal ureteric stones. Methodology: The records of 18 patients who had semirigid ureteroscopy and pneumatic lithotripsy for proximal ureteric stone over a period of 2 years were reviewed. All the patients had computed tomography (CT) abdominal scan to characterize the stones before the surgery. Data on patients’ demographics, stone location, stone size, intraoperative complications, postoperative complications, and stone clearance were retrieved and analysed using proportions, frequency and percentages. Results: The mean age of the patients in years was 44.17±12.32 (range 29– 67). The mean stone size was 15.01±4.51mm with range of 8.3mm–22.0mm. All the patients had impacted stones. Out of the 18 patients, 6 (33.3%), 11 (61.1%) and 1(5.6%) had grade II, grade III and grade IV hydronephrosis respectively. Three (16.7%) patients had mucosal flap, 6 (33.3%) had mucosal abrasion, 2(11.1%) patients had transient haematuria postoperatively while 1 (5.6%) patient had UTI. Successful disintegration and retrieval of stone fragments occurred in 12(66.7%) patients. In 4(22.2%) patients, stone/stone fragments retropulsed into the pelvicalyceal system and the procedure had to be completed with flexible ureteroscopy. In another 2 (11.1%) patients, the procedure was converted to open ureterolithotmy due to oedema and inflammatory polyps, tortuosity of the ureter precluding stone visualization, and stone fragmentation. Conclusion: Treatment of proximal ureteric stones with semirigid ureteroscopy and pneumatic lithotripsy gives acceptable stone free rate with minimal complications. But complementary ancillary procedures, particularly flexible ureteroscopy should be anticipated to achieve a higher stone clearance rate.