URETEROSCOPIC STONE REMOVAL IN THE DISTAL URETER - WHY CHANGE

Purpose: We compared our experience with ureteroscopic stone basket ma nipulation under fluoroscopic guidance to ultrasound ureterolithotrips y for distal ureteral stone removal. Materials and Methods: Retrospect ively, we analyzed the medical records of 981 patients with ureteral c alculi between January 1994 and December 1995, of whom 483 (49%) were treated for stones in the lower ureter and constituted our study group . The decision of when to perform lithotripsy (group 2) versus a baske t procedure (group I) was based on a prospective nonrandomized study a nd both groups were compared historically. All 322 patients in group 1 (mean age 49 years, range 14 to 86) primarily underwent ureteroscopic stone basket manipulation using the 4-wire Segura basket. If the cal culus could not be removed with the basket and another procedure was n ecessary, the case was considered a failure. The 161 patients in group 2 (mean age 37 years, range 14 to 74) underwent initially ultrasound ureterolithotripsy for stone fragmentation followed or not by removal of the fragments with the basket. Stone size did not differ significan tly between groups 1 (mean 0.9 cm., range 0.6 to 1.7) and 2 (mean 0.8 cm., range 0.7 to 2.0). Ureteroscopy was performed in both groups with epidural anesthesia and on an outpatient basis in the majority of cas es. Results: The stone-free rate after 1 procedure was 98.1 and 95.6% in groups 1 and 2, respectively. For group 2 versus group 1 the operat ive time was longer (mean 50, range 25 to 90 versus mean 19 minutes, r ange 11 to 40, respectively, p <0.001), the complication rate was grea ter (16.1 versus 4.3%, respectively, p <0.001) and average hospital st ay was longer (2.1 versus 0.15 day, respectively, p <0.001). Conclusio ns: Ureteroscopic stone treatment with basket manipulation under fluor oscopic guidance or ultrasound ureterolithotripsy provided a high ston e-free rate. However, stone removal with the basket manipulation techn ique should be considered the first choice for treatment of small dist al ureteral calculi based on the minimal morbidity, and short operativ e and recovery times.