Outcomes of Semirigid Ureteroscopy with Pneumatic Lithotripsy for Up per Ureteric Stones: A Five-year Experience in Yemen (June 2018–June 2023)
Abstract:
Introduction and objectives: Urolithiasis is the third most common urological condition, following urinary tract infection and prostate disease. It requires active management due to its high prevalence, recurrence rates, and potential complications. One treatment modality involves the use of a semi-rigid ureteroscope with pneumatic lithotripsy (SUPL). This study aimed to evaluate the outcomes, effectiveness, safety, and feasibility of SUPL for the treatment of upper ureteric stone (UUS) in low-income countries, such as Yemen, where advanced lithotripter technologies are not available.
Methods: comprehensive retrospective analysis was conducted on a cohort comprising 212 patients. Treated for UUS utilized Storz semi-rigid ureteroscope with Swiss pneumatic lithotripter, between June 2018 and June 2023 at 48 typical and Alyemen-Alsaeed hospitals Sana'a, all procedures were performed by one urologist.
Results: A total of 212 patients underwent SUPL for UUS, with an average age of 45.5 years and a predominantly male population (62.7%). The mean operative time was 46.5 minutes (range: 24-69 minutes). Stone sizes ranged from 8 to 22 mm, categorized into two groups based on size: 139 patients had stones ≤ 1.5 cm (including 17 cases with stones < 1 cm), and 73 patients had stones > 1.5 cm. The overall stone-free rate (SFR) was 89.2% (189/212). Specifically, for patients with stones ≤ 1.5 cm, the SFR was 93.5% (130/139), with a 95% confidence interval ranging from 88.2% to 96.7%. Conversely, patients with stones > 1.5 cm exhibited a slightly lower SFR of 80.8% (59/73), with a 95% confidence interval ranging between 70.1% and 88.0%. Of the total number of patients, fourteen (6.6%) experienced retrograde migration of stones to the renal pelvis. Intraoperative ureteral perforation, observed in four cases (1.9%), resulted in the termination of the procedure. Previous ureteral strictures impeding the advancement of the ureteroscope were noted in five cases (2.3%). Postoperative urinary tract infections (UTIs) were detected in 8.7% of patients. However, no severe complications such as sepsis or avulsion were reported during the study.
