[The long-term "stone trail": treatment experience using ureterorenoscopy]

A residual "stone trace" is not a rare finding after impulse destruction of large stones. A complex of conservative treatment of lithotripsy of the fragments and sand which comprise the sand trace are not universally effective. Long-standing "stone trace" is characterized by a single or several large fragments of the crushed stone, failure of both conservative and lithotripsy treatment, the trace existence surpassing 1 month. Ureterorenoscopy was used for the trace management in 41 patients. The trace (2-6.5 cm in length) was localized in the lower, middle and upper third of the ureter in 28, 10 and 3 patients, respectively. Transureteral lithotripsy and lithoextraction were made by ureterorenoscopes (11.5 and 12.5 Tr) and miniscope (9.5 Tr). Lithotripsy was made using ultrasonic electrohydraulic and pneumatic lithotriptors. In transureteral endoscopic destruction of long-standing traces the authors point out apparent inflammation in the ureteral wall at the trace side, ready-to-bleed ureteral mucosa, poor endoscopic image, preferable initial use of atraumatic pneumatic lithotripsy followed by lithoextraction, previous renal drainage by means of transcutaneous puncture nephrostomy in acute inflammation or advanced retention changes of the kidney, etc. Ureterorenoscopy proved able to eliminating the traces. Side effects were reported in the form of an episode of pyelonephritis aggravation cured conservatively in 17% of the cases.