Proksimal Üreter Taşlarının Retrograd Tedavisinde Holmiyum: YAG Lazer Litotripsisinin Başarısızlığını Öngören Faktörler

Background: This retrospective study aimed to evaluate clinical and radiological parameters associated with unsuccessful outcomes of semi-rigid ureteroscopy using holmium: YAG laser lithotripsy in patients with proximal ureteral stones.Materials and Methods: A total of 212 patients who underwent semi-rigid URS for proximal ureteral stones between 2015 and 2025 were retrospectively analyzed. Patients were classified into three groups according to postoperative outcomes: Group 1 (stone-free, n=158), Group 2 (retropulsion, n=32), and Group 3 (residual fragments >3 mm, n=22). Demographic and stone-related parameters, including hydronephrosis grade, stone density, stone volume, and stone-to-renal pelvis distance, were compared statistically among the groups.Results: The overall stone-free rate was 74.5%. Severe hydronephrosis was significantly more frequent in the retropulsion group compared to the stone-free group (46.9% vs. 12.7%, p<0.001), and was associated with a 6.1-fold increased risk of stone migration (95% CI: 2.6-14.1, p<0.001). Mean stone density was significantly higher in Group 2 compared to Group 1 (916±239 HU vs. 692±234 HU, p<0.001) and in Group 3 compared to Group 1 (868±191 HU vs. 692±234 HU, p=0.003). Median stone volume was also significantly greater in Group 2 than in Group 1 (459 mm³ vs. 168 mm³, p<0.001). Additionally, stone-to-renal pelvis distance was significantly shorter in Group 2 (7.5 mm vs. 27 mm, p<0.001).Conclusions: High-grade hydronephrosis, increased stone density, larger stone volume, and shorter stone-to-renal pelvis distance are significantly associated with unsuccessful outcomes of semi-rigid ureteroscopic holmium: YAG laser lithotripsy in proximal ureteral stones. Preoperative evaluation of these parameters may help optimize surgical planning and patient counseling.