From the Guidelines
The definitive management for a persistent left distal ureteral stone with mild hydronephrosis is ureteroscopic stone removal, preferably using a rigid or semirigid ureteroscope [ 1 ].
Key Considerations
- Ureteroscopic treatment of distal ureteral stones is uniformly associated with high success rates and low complication rates, with an overall stone-free rate of 94% [ 1 ].
- Rigid or semirigid ureteroscopes are preferred for distal ureteral stones, as they are more successful than flexible URS, particularly for larger stones [ 1 ].
- The use of improved instrumentation, such as the holmium:YAG laser, has contributed to the enhanced success of ureteroscopic management of ureteral calculi [ 1 ].
Pre- and Post-Procedure Care
- Pre-procedure, patients should receive analgesia and anti-anxiety medication as needed.
- Post-procedure, patients should be prescribed a course of oral antibiotics and oral pain management.
- The overall complication rates for ureteroscopic stone removal are relatively low, with ureteral perforation rates reduced to less than 5% and long-term complications such as stricture formation occurring with an incidence of 2% or less [ 1 ].
From the Research
Definitive Management for Persistent Left Distal Ureteral Stone with Mild Hydronephrosis
- The definitive management for a persistent left distal ureteral stone with mild hydronephrosis is ureteroscopy 2.
- Ureteroscopy is a minimally invasive procedure that involves the use of a small scope to visualize the stone and break it up into smaller pieces that can be easily removed 2, 3.
- The use of holmium laser with a 365 μm fiber has been shown to be effective and safe for treating nephrolithiasis, including distal ureteral stones 4.
- Flexible ureteroscopic lithotripsy (FURL) using a holmium laser is a highly efficacious treatment option for distal ureteral stones, with a high stone-free rate and low complication rate 3, 4.
- The choice of treatment may depend on the size and location of the stone, as well as the patient's overall health and medical history 2, 3.
- Emergent lithotripsy, either ureteroscopic or extracorporeal, can be offered as an effective and safe treatment for patients with symptomatic ureteral stones 2.