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Vol. 45. Issue 9.
Pages 569-575 (November 2021)
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Vol. 45. Issue 9.
Pages 569-575 (November 2021)
Original article
Endourological treatment for lumbar ureteral stones. What are the benefits of flexible ureterorenoscopy?
Tratamiento endourológico de la litiasis ureteral lumbar. ¿Qué aporta la ureterorrenoscopia flexible?
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F. Natal Alvareza,
Corresponding author
fernando.natal.6@gmail.com

Corresponding author.
, S. Martín Martína, J.R. Torrecilla García-Ripolla, J.M. Díaz Romeroa, J. Calleja Escuderoa, M. Bedate Núñeza, J.L. Soto Rodrígueza, F.M. Lara Péreza, A. Ruano Mayoa, A. Zamora Horcajadaa, L.A. Cuéllar Martína, M.F. Muñoz Morenob, J.R. Cortiñas Gonzáleza
a Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b Unidad de Apoyo a la Investigación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Tables (4)
Table 1. Demographic variables.
Table 2. Surgical variables.
Table 3. Univariate analysis.
Table 4. Multivariate analysis.
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Abstract
Introduction and objectives

Currently, there are no established criteria regarding treatment for lumbar ureteral stones. The objective of this work is to present our results in the endourological treatment of this pathology, analyzing the variables associated with the use of the flexible ureterorenoscope.

Material and methods

Retrospective review of 103 patients who underwent retrograde URS with semi-rigid or flexible ureterorenoscope. Proximal location: L2–L3. Medial location: L4–L5. Semirigid URS was the initial treatment, with conversion to flexible URS when it was required to complete the procedure. Success was defined as absence of residual fragments (6 weeks). Demographic, surgical, immediate postoperative variables, and those related to the stone, were analyzed. Their correlation with the use of the flexible ureterorenoscope was evaluated.

Results

Mean age: 57.2 years (SD 15.6); there were 73 men (70.9%). Stone size: 8 mm (range 4–30; IQR 4.5). Proximal location: 58 (56.3%). Previous JJ: 44.7%. Previous nephrostomy: 10.7%. Semirigid URS with conversion to flexible URS: 51 (49.5%). Impacted stones: 28.2%. Intraoperative complications: 2 (1.9%). Postoperative JJ: 84.5%. Immediate postoperative complications: 23 (22.3%) (Clavien-Dindo I–II: 91.3%). Postoperative ureteral stricture: 5.8%. Success: 88.4%. Residual fragments: 12 (11.7%). Spontaneous passage: 6 (50%). Greater performance of flexible URS in proximal ureteral stones (p = 0.001) of more than 11 mm (p = 0.02) in univariate analysis, and in proximal stones [OR 3.5; 1.5–8.1; p = 0.004] in multivariate analysis.

Conclusions

Endourological treatment obtained a high success rate in our sample. Size greater than 11 mm and proximal ureteral location in univariate and multivariate analysis, respectively, behaved as predictors of flexible URS.

Keywords:
Lumbar ureteral stones
Flexible ureterorenoscopy
Resumen
Introducción y objetivos

Actualmente, no existe un criterio claro para el tratamiento de la litiasis ureteral lumbar. El objetivo de este trabajo es presentar nuestros resultados en el tratamiento endourológico de esta patología y analizar las variables que aconsejen la utilización del ureterorrenoscopio flexible.

Material y métodos

Revisión retrospectiva de 103 pacientes operados mediante ureterorrenoscopia (URS) por vía retrógrada, utilizando un ureterorrenoscopio semirrígido o flexible. Se consideró localización proximal en L2–L3 y localización media en L4–L5. URS semirrígida inicial y reconversión a URS flexible cuando fue imposible finalizar la intervención o fue necesaria para completar el tratamiento. Se consideró éxito a la ausencia de fragmentos residuales (6 semanas). Se hizo un análisis de variables demográficas, litiásicas, quirúrgicas y postoperatorias inmediatas y se comparó el uso del ureterorrenoscopio flexible con algunas de ellas.

Resultados

La edad media de los pacientes fue 57,2 años (DE 15,6); 73 eran hombres (70,9%). Tamaño litiásico: 8 mm (rango 4–30; RIQ 4,5). Localización proximal: 58 (56,3%). JJ previo: 44,7%. Nefrostomía previa: 10,7%. URS semirrígida con reconversión a URS flexible: 51 (49,5%). Litiasis impactada: 28,2%. Complicaciones intraoperatorias: 2 (1,9%). JJ postoperatorio: 84,5%. Complicaciones postoperatorias inmediatas: 23 (22,3%) (Clavien-Dindo I–II: 91,3%). Estenosis ureteral postoperatoria: 5,8%. Éxito: 88,4%. Restos: 12 (11,7%), expulsión espontánea 6 (50%). Mayor realización de URS flexible en litiasis proximales (p = 0,001) y mayores de 11 mm (p = 0,02) en análisis univariante y en litiasis proximales (OR 3,5; 1,5–8,1; p = 0,004) en análisis multivariante.

Conclusiones

El tratamiento endourológico ha obtenido un elevado porcentaje de éxito en nuestra muestra. El tamaño superior a 11 mm en análisis univariante, y la situación ureteral proximal en análisis uni y multivariante han sido factores predictores de realización de URS flexible.

Palabras clave:
Litiasis ureteral lumbar
Ureterorrenoscopia flexible

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