Incidence of ureteral stricture after ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi.

BACKGROUND AND PURPOSE: We investigated the incidence of ureteral stricture in patients treated with ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi.

PATIENT AND METHODS: Between April 2006 and January 2009, 154 patients requiring ureterorenoscopic pneumatic lithotripsy for distal ureteral calculi were enrolled into the study. We evaluated the stone size, impaction of a stone, the need for ureteral orifice dilatation and the need for application of double-J stent.

RESULTS: A total of 154 patients underwent URS-PL for ureteral calculi. Mean calculi diameter was 12.17 +/- 2.54 (range: 5-20 mm). Stone free rates after the first URS-PL operation were 97.4% of patients. In 2 patients (1.29%), ureteral perforation occurred as an early complication. We observed deep mucosal injury in 9 patients (5.84%). Partial stricture (partial obstruction) was observed in 9 patients (5.84%). Of 9 patients who had an ureteral stricture postoperatively, 7 patients had ureteral calculi > or = 10 mm, 2 patients had calculi < 10 mm. We observed ureteral stricture in 2 (8.69%) out of 23 patients who had calculi < 10 mm, and in 7 (5.34%) out of 131 patients who had calculi > or = 10 mm (p > 0.05). Ureteral stricture was observed in 2 (13.33%) out of 15 patients who had impacted calculi, and in 7 (5.03%) out of 139 patients who did not have impacted calculi (p < 0.05). We observed ureteral stricture in 3 (6.25%) out of 48 patients who required ureteral dilatation, and in 6 (5.66%) out of 106 patients who did not require ureteral dilatation (p > 0.05). Ureteral stricture was observed in 6 (15%) out of 40 patients who required ureteral double-J catheter placement, and in 3 (2.63%) out of 114 patients who did not require ureteral double-J catheter placement (p < 0.05).

CONCLUSION: The results of our study have demonstrated that the success rate was not related to the stone dimension, but the time of operation was found to be increased with larger stones. Main risk factors for formation of ureteral stricture were impacted ureteral calculi and reasons which merits double-J catheter placement like mucosal damage, perforation, impacted calculi and high stone burden.