Comparison of outcomes of ureteroscopy for ureteral calculi located above and below the pelvic brim

Objectives. To compare the safety and efficacy of ureteroscopy performed fo r proximal and distal ureteral calculi in a contemporary cohort. Ureterosco py has been used most often for distal ureteral calculi. However, advances in endoscopic equipment have facilitated access to the proximal urinary tra ct and have broadened the indications for ureteroscopy. Methods. One hundred ninety-one patients underwent rigid and/or flexible ur eteroscopy for ureteral calculi at the University of Michigan between Janua ry 1, 1997 and September 30, 1999. Only 7 patients with either bilateral ca lculi or steinstrasse were excluded. The final cohort consisted of 184 pati ents who underwent ureteroscopy for distal stones (n = 103) or middle/upper ureteral stones (n = 81). Results. Bivariate analyses of pretreatment and perioperative characteristi cs were used to assess the sample population. The initial success rate for the distal and proximal ureteral calculi was 96% and 78%, respectively (P = 0.0008). After a "second-look" procedure in 4 and 7 patients with distal a nd proximal calculi, respectively, the success rate improved to 99% and 88% , respectively (P = 0.004). No differences were noted between groups regard ing the intraoperative (P = 0.51) or postoperative (P = 0.85) complication rates. Multivariate logistic regression analysis confirmed that larger ston e size (odds ratio 1.2, P = 0.0006) and proximal ureteral location (odds ra tio 4.8, P = 0.01) are independent predictors of treatment failure. Conclusions. Ureteroscopic management of proximal and distal ureteral calcu li is highly successful, and the difference in success rates has narrowed s ubstantially. Currently, no greater risk is conferred to the patient for en doscopy of more proximal ureteral calculi. UROLOGY 58: 351-356, 2001. (C) 2 001, Elsevier Science Inc.