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Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm

Volume 10, Issue 2

Original Article / Published: November 2022


K. Hristov, K. Petkova, D. Petrova, P. Petrov, O. Gatsev, V. Todorova, I. Saltirov

Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria


Introduction and objective: Optimal management of large impacted proximal ureteral stones remains controversial. Retrograde ureteroscopy in these cases may be challenging due to the presence of mucosal edema and inflammation, tortuousity and unusual angulations of the ureter. The objective of this study is to evaluate the efficacy and safety of retrograde ureteroscopy (URS) for the treatment of impacted proximal ureteral stones larger than 10 mm.

Material and methods: A prospectively collected database of 143 patients, who underwent retrograde ureteroscopy for impacted proximal ureteral stones ≥ 10 mm between January 2016 and December 2021, was reviewed. Data on patients’ preoperative characteristics, stone-free rates, complications and auxiliary procedures was analyzed.

Results: Patients’ mean age was 54.2±13.4 years, and male-to-female ratio – 67.8%/32.2%. Mean stone length was 14.2±5.4 mm and mean stone width – 9.6±2.9 mm. 26 (18.2%) patients were on preoperative anticoagulation therapy, which could not be discontinued. 26 patients (18.2%) had preoperative drainage with ureteral stent JJ, and 7 (4.9%) – with percutaneous nephrostomy. Stone-free rate after single procedure was 88.8%. Mean operative time was 44.2±15.4 min. There were no cases of failed endoscopic access to the stone. Flexible ureteroscopy was performed in 34 (23.8%) cases. Postoperative drainage was ureteral stent JJ in 71 (49.7%) patients and ureteral catheter for 24 h – in 33 (23.1%). Most common postoperative complications were fever in 5 (3.5%) and postoperative renal colic – in 5 (3.5%) patients. 8 patients (5.6%) underwent SWL for treatment of residual fragments and 2 (1.4%) – retrograde intrarenal surgery.

Conclusions: The results from this study demonstrate that retrograde ureteroscopy is an effective and safe treatment modality for impacted proximal ureteral stones ≥ 10 mm. Its high stone-free rate and low complication rate make retrograde URS a suitable first-line treatment for anticoagulated patients with impacted proximal ureteral stones, who are at increased risk of complications from the antegrade approach


  1. Bagley DH. Ureteroscopic stone retrieval: rigid versus flexible endoscopes. Semin Urol. 1994 Feb;12(1):32-8.
  2. Türk C, Neisius A, Petrik A. Members of the European Association of Urology (EAU) Guidelines O£ce. Guidelines on Urolithiasis. In: EAU Guidelines, edition presented at the 32nd Annual EAU Congress, London 2017. Available at: http:// Accessed February 18th, 2018
  3. Assimos D, Krambeck A, Miller N. Surgical Management of Stones: American Urological Association/Endourological Society Guideline, 2016. Available at: https://www.auanet. org/guidelines/surgical-management-of-stones-(aua/ en­dourological-society-guideline-2016) Accessed February 18th, 2018
  4. Liong ML, Clayman RV, Gittes RF, Lingeman JE, Huffman JL, Lyon ES. Treatment options for proximal ureteral urolithiasis: review and recommendations. J Urol. 1989 Mar;141(3):504-9. doi: 10.1016/s0022-5347(17)40874-3.
  5. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997 Nov;158(5):1915-21. doi: 10.1016/s0022-5347(01)64173-9.
  6. Lingeman JE, Shirrell WL, Newman DM, Mosbaugh PG, Steele RE, Woods JR. Management of upper ureteral calculi with extracorporeal shock wave lithotripsy. J Urol. 1987 Oct;138(4):720-3. doi: 10.1016/s0022-5347(17)43351-9.
  7. Dretler SP, Keating MA, Riley J. An algorithm for the management of ureteral calculi. J Urol. 1986 Dec;136(6):1190-3. doi: 10.1016/s0022-5347(17)45279-7.
  8. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M et al. ; EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol. 2007 Dec;178(6):2418-34. doi: 10.1016/j.juro.2007.09.107.
  9. Li X, He Z, Wu K, Li SK, Zeng G, Yuan J et al. Chinese minimally invasive percutaneous nephrolithotomy: the Guangzhou experience. J Endourol. 2009 Oct;23(10):1693-7. doi: 10.1089/end.2009.1537
  10. Seitz C, Tanovic E, Kikic Z, Fajkovic H. Impact of stone size, location, composition, impaction, and hydronephrosis on the efficacy of holmium:YAG-laser ureterolithotripsy. Eur Urol. 2007 Dec;52(6):1751-7. doi: 10.1016/j.eururo.2007.04.029. Epub 2007 Apr 18.
  11. Sofer M, Watterson JD, Wollin TA, Nott L, Razvi H, Denstedt JD. Holmium:YAG laser lithotripsy for upper urinary tract calculi in 598 patients. J Urol. 2002 Jan;167(1):31-4. doi: 10.1016/s0022-5347(05)65376-1.
  12. Pierre S, Preminger GM. Holmium laser for stone management. World J Urol. 2007 Jun;25(3):235-9. doi: 10.1007/s00345-007-0162-y.
  13. Jiang H, Wu Z, Ding Q, Zhang Y. Ureteroscopic treatment of ureteral calculi with holmium: YAG laser lithotripsy. J Endourol. 2007 Feb;21(2):151-4. doi: 10.1089/end.2006.0209.
  14. Leijte JA, Oddens JR, Lock TM. Holmium laser lithotripsy for ureteral calculi: predictive factors for complications and success. J Endourol. 2008 Feb;22(2):257-60. doi: 10.1089/end.2007.0299.
  15. Erhard M, Salwen J, Bagley DH. Ureteroscopic removal of mid and proximal ureteral calculi. J Urol. 1996 Jan;155(1):38-42. Erratum in: J Urol 1996 Mar;155(3):1039.
  16. Harmon WJ, Sershon PD, Blute ML, Patterson DE, Segura JW. Ureteroscopy: current practice and long-term complications. J Urol. 1997 Jan;157(1):28-32. doi: 10.1016/s0022-5347(01)65272-8.
  17. Grasso M, Conlin M, Bagley D. Retrograde ureteropyeloscopic treatment of 2 cm. or greater upper urinary tract and minor Staghorn calculi. J Urol. 1998 Aug;160(2):346-51.
  18. Wu CF, Shee JJ, Lin WY, Lin CL, Chen CS. Comparison between extracorporeal shock wave lithotripsy and semirigid ureterorenoscope with holmium:YAG laser lithotripsy for treating large proximal ureteral stones. J Urol. 2004 Nov;172(5 Pt 1):1899-902. doi: 10.1097/01.ju.0000142848.43880.b3.
Volume 10, Issue 2


ureteral stones, retrograde ureteroscopy

How to cite this article:

Hristov K, Petkova K, Petrova D, Petrov P, Gatsev O, Todorova V, Saltirov I. Efficacy and safety of retrograde ureteroscopy for the treatment of impacted proximal ureteral stones larger than 10 mm. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(2): 38-42

Corresponding author:

Dr. Konstantin Hristov

Department of Urology and Nephrology
Military Medical Academy of Sofia

3 “Georgi Sofiiski” blvd.
Sofia 1606, Bulgaria