Category: Clinical Stones: Ureteroscopy

MP22-8 - Grading system and its associated factors of inflammatory change of ureteral mucosa in ureter stone disease.

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

In ureterolithotripsy, we often find ureteral mucosa edema or fibroepithelial polyps with impacted ureter stones. Those mucosal changes make surgery hard and induce complications including ureteral injury or infections. However, it is difficult to predict change of ureteral mucosa or impacted ureter stone by computed tomography or other imaging exam. Therefore, we suggest new grading system of inflammatory change of ureteral mucosa in ureter stone disease, and analyze associated factors.


Methods :

153 stones of 142 patients, who underwent ureterolithotripsy between April 2015 and March 2018 by a single surgeon, were reviewed. Patients who underwent extracorporeal shock wave lithotripsy for the same stone before surgery were excluded. From the ureteroscopic image, status of ureteral mucosa where the stone locate is classified into four grades. “Grade 0” is defined as normal mucosa, “Grade 1” indicates small change and edema of mucosa and stone is not impacted. “Grade 2” indicates moderate edema of mucosa or some fibroepithelial polyps and stone is mild impacted. “Grade 3” indicates severe edema of mucosa or highly developed fibroepithelial polyps and severely impacted stone (Fig. 1). We evaluated patients’ sex and age, stone size and location, hydronephrosis grade (Society of Fetal Ultrasound (SFU) grade) in each grade.


Results : The number of patients were 26 in grade 0, 51 in grade 1, 44 in grade 2, and 22 in grade 3. The mean ages were 60.7, 61.6, 57.9, and 49.7 years old, respectively. The mean size of stone were 8.4 mm, 10.0 mm, 9.5 mm, and 12.0 mm, respectively. In all grades, the most common stone location is upper ureter. Analyzing hydronephrosis, in grade 0, SFU grade 2 was the most and 3 was the second. In grade 1, SFU grade 3 was the most and 2 was the second. In grade 2 and 3, SFU grade 4 was the most and 3 was the second (Table 1). The SFU grade of hydronephrosis was the only associated factor with inflammatory change of ureteral mucosa in ureter stone (Table 2).


Conclusions : In conclusions, severe hydronephrosis in preoperative computed tomography or ultasonography image would favour severe inflammatory change of ureteral mucosa and impacted ureter stone. The operator could predict the status of ureteral mucosa around stone and prepare with caution.

Seungsoo Lee

Assistant professor
Dept. of Urology, Pusan National University Yangsan Hospital
Yangsan, Kyongsang-namdo, Republic of Korea

Jae Min Chung

Yangsan, Kyongsang-namdo, Republic of Korea

Sung-Woo Park

Yangsan, Kyongsang-namdo, Republic of Korea

Ji-Yeon Han

Yangsan, Kyongsang-namdo, Republic of Korea

Jong Kil Nam

Yangsan, Kyongsang-namdo, Republic of Korea

Moon Kee Chung

Yangsan, Kyongsang-namdo, Republic of Korea

Sang Don Lee

Yangsan, Kyongsang-namdo, Republic of Korea