Endoscopic Management for Complicated Cases with Lower Large Ureter Stones; Challenge Cases.
Publication Type
Conference Paper

Purpose: To evaluate the feasibility of ureterorenoscopic management in the treatment of complicated cases with large lower ureter stones.

Material and Methods:  Four patients (3 males, 1  female)  with median age of 38 year-old(range; 24-73 years) who underwent ureterorenoscopic management  due to large lower ureter stones between June 2013-Septemper 2013 were included. All patients were complicated cases; one was anuric (24-year old,  blood creatinine  2.8 mg/dl)  with  large ureter stone above the iliac vessels level ( stone diameters 1.8 × 1 cm in the left side and 1×1 cm stone in the UP junction in the right side) , the second case (73-year old, diabetic, hypertensive and over obese) had  1.8×1 cm stone in the left lower ureter with high grade hydroureteronephrosis, the third case (52-year old)  had 1.4×1 cm stone in the lower right ureter stone  with high grade hydroureternephrosis, the last case (24-year old, female) had 1.2×1 cm stone in the left lower ureter with acute attack of obstructive peylonephritis, fever and chill. All patients had general anesthesia except one had spinal . No DJS was placed for any patient, and the average intra-operative time was 50 minutes(range 30-120 minutes). Pneumatic lithotripter (Elmed-Turkey) was used and the average number of shocks was 1200 shocks (range; 700-3300). Stone free was defined as no fragment more than 5mm on the kidney ureter bladder(KUB) for one month follow up.        

Results: All patients were stone free after two weeks of the operation except one had 6mm fragment in the lower ureter without symptoms.  This patients had the stone above the iliac vessels level . All patients were discharged in the first post operative day without postoperative complications.  

Conclusion: Endoscopic management for large lower ureter stone is feasible options. The location of the stone in the ureter especially above the iliac   vessels level  may prolong the operation and make it more difficult. Further studies including larger number of  patients should be carried out to confirm our findings.

Conference Title
10 th arab urology association meeting
Conference Country
Conference Date
Jan. 1, 2013 - Jan. 1, 2013
Conference Sponsor
10 th arab urology association meeting