Category: Stones: Ureteroscopy
Introduction & Objective : Impacted ureteral stones present a unique challenge. They could be impacted as a result of chronic mucosal overgrowth, or attempted retrieval of an oversized calculus. Presented here is a video of practical ways of dealing with these difficult operative situations.
In the first case, an attempt to retrieve an oversized calyceal calculus using 1.5 Fr Halo Nitinol Basket resulted in the stone being caught at the ureteral mucosa proximal to the edge of a 11/13 Fr ureteral access sheath. A 200 microns Laser fiber was introduced through the working channel of the flexible ureteroscope parallel to the basket and the stone was fragmented inside the basket. The second case, the mucosa overlying the stone was unroofed and the stone was dusted.The third case, the patient was undergoing robotic partial nephrectomy and he had a known stone in the proximal epsilateral ureter. Robotic Ureterolithotomy was performed. A ureteral JJ stent was placed in all three cases.
The impacted stones were treated successfully and the stents were removed cystoscopically in the office after 3 weeks in the ureteroscopy patients and 6 weeks in the ureterolithotomy patient.
Impacted stones can be managed endoscopically or laparoscopically based on the situation and other comorbidities.
Khaled Fareed– Assistant Professor, Cleveland Clinic, Cleveland, Ohio
Khaled Fareed, MD
Assistant Professor of Urology, Lerner College of Medicine at Case Western Reserve University and Staff Urologist at Glickman Urological & Kidney Institiue at Cleveland Clinic
Graduated from Assiut University Medical School, Egypt in 1994, completed 2 years residency training in Assiut University Hospital. finished 2 years Research fellowship at the University of Texas, Southwestern Medical Center, and Residency training in urology at the same center. joined Cleveland Clinic in 2007 and been on staff. interests in EndoUrology, Advanced laparoscopy, image-guided Therapy, Robotics and BPH, Mens voiding dysfunction.