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

Area of Science:

• Urology
• Endourology
• Nephrology

Background:

• Residual stone fragments, termed
• stone trace
• can persist after impulse destruction of large stones.
• Conservative and standard lithotripsy treatments are often ineffective for these complex cases.
• Long-standing stone traces, defined by large fragments and persistence over a month, pose a significant clinical challenge.

Observation:

• This study evaluated ureterorenoscopy for managing residual stone traces in 41 patients.
• Traces ranged from 2-6.5 cm and were located in various ureteral segments.
• Ureterorenoscopic procedures involved transureteral lithotripsy and lithoextraction using different ureteroscopes and lithotriptors.

Findings:

• Ureterorenoscopy successfully eliminated residual stone traces in all treated patients.
• Procedures revealed ureteral wall inflammation and friable mucosa, necessitating careful technique.
• Atraumatic pneumatic lithotripsy followed by lithoextraction was often preferred, with pre-procedure renal drainage considered for severe cases.

Implications:

• Ureterorenoscopy is a viable and effective treatment for long-standing residual ureteral stone traces.
• Management requires careful endoscopic technique due to ureteral inflammation.
• Potential complications include a 17% rate of pyelonephritis aggravation, manageable with conservative treatment.